ObjectiveThe aim of this study is to explore the relationship between active travel and psychological wellbeing.MethodThis study used data on 17,985 adult commuters in eighteen waves of the British Household Panel Survey (1991/2–2008/9). Fixed effects regression models were used to investigate how (i.) travel mode choice, (ii.) commuting time, and (iii.) switching to active travel impacted on overall psychological wellbeing and how (iv.) travel mode choice impacted on specific psychological symptoms included in the General Health Questionnaire.ResultsAfter accounting for changes in individual-level socioeconomic characteristics and potential confounding variables relating to work, residence and health, significant associations were observed between overall psychological wellbeing (on a 36-point Likert scale) and (i.) active travel (0.185, 95% CI: 0.048 to 0.321) and public transport (0.195, 95% CI: 0.035 to 0.355) when compared to car travel, (ii.) time spent (per 10 minute change) walking (0.083, 95% CI: 0.003 to 0.163) and driving (− 0.033, 95% CI: − 0.064 to − 0.001), and (iii.) switching from car travel to active travel (0.479, 95% CI: 0.199 to 0.758). Active travel was also associated with reductions in the odds of experiencing two specific psychological symptoms when compared to car travel.ConclusionThe positive psychological wellbeing effects identified in this study should be considered in cost–benefit assessments of interventions seeking to promote active travel.

Commuting between home and work is routinely performed by workers and any wellbeing impacts of commuting will consequently affect a large proportion of the population. This paper presents findings from analyses of the impact of commuting (time and mode) on multiple aspects of Subjective Well-Being (SWB), including: satisfaction with life overall and the SWB sub-domains of job satisfaction, satisfaction with leisure time availability and self-reported health. Measures of strain and mental health (GHQ-12) are also examined. Six waves of individual-level panel data from Understanding Society (2009/10 to 2014/15) are analysed, providing a sample of over 26,000 workers living in England. Associations between commuting and SWB are identified, paying particular attention to those arising from individual changes in commuting circumstances over the six waves. It is found that longer commute times are associated with lower job and leisure time satisfaction, increased strain and poorer mental health. The strongest association is found for leisure time satisfaction. Despite these negative associations with the SWB sub-domains, longer commute times were not associated with lower overall life satisfaction (except where individuals persisted with them over all six waves). Workers in England appear to be successful in balancing the negative aspects of commuting against the wider benefits, e.g. access to employment, earnings and housing. Differences amongst selected population sub-groups are also examined. The job satisfaction of younger adults and lower income groups are not found to be negatively associated with longer commute times; longer commute times are more strongly negatively associated with the job satisfaction of women compared to men. With respect to mode of transport, walking to work is associated with increased leisure time satisfaction and reduced strain. The absence of the commute, via working from home, is associated with increased job satisfaction and leisure time satisfaction. Overall, the study indicates that shorter commute times and walkable commutes can contribute to improved SWB-particularly through the release of leisure time. But life satisfaction overall will only be maintained if the benefits of undertaking the commute (earnings and satisfactory housing/employment) are not compromised.

This review provides a critical overview of what has been learnt about commuting's impact on subjective wellbeing (SWB). It is structured around a conceptual model which assumes commuting can affect SWB over three time horizons: (i) during the journey; (ii) immediately after the journey; and (iii) over the longer term. Our assessment of the evidence shows that mood is lower during the commute than other daily activities and stress can be induced by congestion, crowding and unpredictability. People who walk or cycle to work are generally more satisfied with their commute than those who travel by car and especially those who use public transport. Satisfaction decreases with duration of commute, regardless of mode used, and increases when travelling with company. After the journey, evidence shows that the commute experience "spills over" into how people feel and perform at work and home. However, a consistent link between commuting and life satisfaction overall has not been established. The evidence suggests that commuters are generally successful in trading off the drawbacks of longer and more arduous commute journeys against the benefits they bring in relation to overall life satisfaction, but further research is required to understand the decision making involved. The evidence review points to six areas that warrant policy action and research: (i) enhancing the commute experience; (ii) increasing commute satisfaction; (iii) reducing the impacts of long duration commutes; (iv) meeting commuter preferences; (v) recognising flexibility and constraints in commuting routines and (vi) accounting for SWB impacts of commuting in policy making and appraisal.

Objective To evaluate a “telephone first” approach, in which all patients wanting to see a general practitioner (GP) are asked to speak to a GP on the phone before being given an appointment for a face to face consultation. Design Time series and cross sectional analysis of routine healthcare data, data from national surveys, and primary survey data. Participants 147 general practices adopting the telephone first approach compared with a 10% random sample of other practices in England. Intervention Management support for workload planning and introduction of the telephone first approach provided by two commercial companies. Main outcome measures Number of consultations, total time consulting (59 telephone first practices, no controls). Patient experience (GP Patient Survey, telephone first practices plus controls). Use and costs of secondary care (hospital episode statistics, telephone first practices plus controls). The main analysis was intention to treat, with sensitivity analyses restricted to practices thought to be closely following the companies’ protocols. Results After the introduction of the telephone first approach, face to face consultations decreased considerably (adjusted change within practices −38%, 95% confidence interval −45% to −29%; P<0.001). An average practice experienced a 12-fold increase in telephone consultations (1204%, 633% to 2290%; P<0.001). The average duration of both telephone and face to face consultations decreased, but there was an overall increase of 8% in the mean time spent consulting by GPs, albeit with large uncertainty on this estimate (95% confidence interval −1% to 17%; P=0.088). These average workload figures mask wide variation between practices, with some practices experiencing a substantial reduction in workload and others a large increase. Compared with other English practices in the national GP Patient Survey, in practices using the telephone first approach there was a large (20.0 percentage points, 95% confidence interval 18.2 to 21.9; P<0.001) improvement in length of time to be seen. In contrast, other scores on the GP Patient Survey were slightly more negative. Introduction of the telephone first approach was followed by a small (2.0%) increase in hospital admissions (95% confidence interval 1% to 3%; P=0.006), no initial change in emergency department attendance, but a small (2% per year) decrease in the subsequent rate of rise of emergency department attendance (1% to 3%; P=0.005). There was a small net increase in secondary care costs. Conclusions The telephone first approach shows that many problems in general practice can be dealt with over the phone. The approach does not suit all patients or practices and is not a panacea for meeting demand. There was no evidence to support claims that the approach would, on average, save costs or reduce use of secondary care.

BackgroundActive commuting is associated with various health benefits, but little is known about its causal relationship with body mass index (BMI).MethodsWe used cohort data from three consecutive annual waves of the British Household Panel Survey, a longitudinal study of nationally representative households, in 2004/2005 (n=15 791), 2005/2006 and 2006/2007. Participants selected for the analyses (n=4056) reported their usual main mode of travel to work at each time point. Self-reported height and weight were used to derive BMI at baseline and after 2 years. Multivariable linear regression analyses were used to assess associations between switching to and from active modes of travel (over 1 and 2 years) and change in BMI (over 2 years) and to assess dose–response relationships.ResultsAfter adjustment for socioeconomic and health-related covariates, the first analysis (n=3269) showed that switching from private motor transport to active travel or public transport (n=179) was associated with a significant reduction in BMI compared with continued private motor vehicle use (n=3090; −0.32 kg/m2, 95% CI −0.60 to −0.05). Larger adjusted effect sizes were associated with switching to active travel (n=109; −0.45 kg/m2, −0.78 to −0.11), particularly among those who switched within the first year and those with the longest journeys. The second analysis (n=787) showed that switching from active travel or public transport to private motor transport was associated with a significant increase in BMI (0.34 kg/m2, 0.05 to 0.64).ConclusionsInterventions to enable commuters to switch from private motor transport to more active modes of travel could contribute to reducing population mean BMI.