February 19 | 2018

Impacts of Bicycle Infrastructure in Mid-Sized Cities (IBIMS): protocol for a natural experiment study in three Canadian cities

Meghan Winters, Michael Branion-Calles, Suzanne Therrien, Daniel Fuller, Lise Gauvin, David G T Whitehurst, and Trisalyn Nelson

BMJ Open. 2018; 8(1): e019130. Published online 2018 Jan 21. doi:  10.1136/bmjopen-2017-019130  PMCID: PMC5781157



Bicycling is promoted as a transportation and population health strategy globally. Yet bicycling has low uptake in North America (1%–2% of trips) compared with European bicycling cities (15%–40% of trips) and shows marked sex and age trends. Safety concerns due to collisions with motor vehicles are primary barriers.

To attract the broader population to bicycling, many cities are making investments in bicycle infrastructure. These interventions hold promise for improving population health given the potential for increased physical activity and improved safety, but such outcomes have been largely unstudied. In 2016, the City of Victoria, Canada, committed to build a connected network of infrastructure that separates bicycles from motor vehicles, designed to attract people of ‘all ages and abilities’ to bicycling.

This natural experiment study examines the impacts of the City of Victoria’s investment in a bicycle network on active travel and safety outcomes. The specific objectives are to (1) estimate changes in active travel, perceived safety and bicycle safety incidents; (2) analyse spatial inequities in access to bicycle infrastructure and safety incidents; and (3) assess health-related economic benefits.

February 12 | 2018

Effect of air quality alerts on human health: a regression discontinuity analysis in Toronto, Canada

Hong Chen, PhD, Qiongsi Li, MMath, Jay S Kaufman, PhD, Jun Wang, MSc, Ray Copes, MD, Yushan Su, PhD, Tarik Benmarhnia, PhD

The Lancet Planetary Health, Volume 2, No. 1, e19–e26, January 2018  DOI: https://doi.org/10.1016/S2542-5196(17)30185-7



Ambient air pollution is a major health risk globally. To reduce adverse health effects on days when air pollution is high, government agencies worldwide have implemented air quality alert programmes. Despite their widespread use, little is known about whether these programmes produce any observable public-health benefits. We assessed the effectiveness of such programmes using a quasi-experimental approach.


We assembled a population-based cohort comprising all individuals who resided in the city of Toronto (Ontario, Canada) from 2003 to 2012 (about 2·6 million people). We ascertained seven health outcomes known to be affected by short-term elevation of air pollution, using provincial health administrative databases. These health outcomes were cardiovascular-related mortality, respiratory-related mortality, and hospital admissions or emergency-department visits for acute myocardial infarction, heart failure, stroke, asthma, and chronic obstructive pulmonary disease (COPD). We applied a regression discontinuity design to assess the effectiveness of an intervention (ie, the air quality alert programme). To quantify the effect of the air quality alert programme, we estimated for each outcome both the absolute rate difference and the rate ratio attributable to programme eligibility (by intention-to-treat analysis) and the alerts themselves (by two-stage regression approach), respectively.


Between Jan 1, 2003, and Dec 31, 2012, on average between three and 27 daily cardiovascular or respiratory events were reported in Toronto (depending on the outcome). Alert announcements reduced asthma-related emergency-department visits by 4·73 cases per 1 000 000 people per day (95% CI 0·55–9·38), or in relative terms by 25% (95% CI 1–47). Programme eligibility also led to 2·05 (95% CI 0·07–4·00) fewer daily emergency-department visits for asthma. We did not detect a significant reduction in any other health outcome as a result of alert announcements or programme eligibility. However, a non-significant trend was noted towards decreased asthma-related and COPD-related admissions.


In this population-based cohort, the air quality alert programme was related to some reductions in respiratory morbidity, but not any other health outcome examined. This finding suggests that issuing air quality alerts alone has a limited effect on public health and that implementing enforced public actions to reduce air pollution on high pollution days could be warranted. Together with accumulating evidence of substantial burden from long-term air pollution exposure, this study underscores the need for further strengthening of global efforts that can lead to long-term improvement of overall air quality.


Public Health Ontario, Canadian Institutes for Health Research.

February 5 | 2018

Evaluating street view exposure measures of visible green space for health research.

Larkin AHystad P.

J Expo Sci Environ Epidemiol. 2018 Jan 19. doi: 10.1038/s41370-018-0017-1. [Epub ahead of print]


Urban green space, or natural environments, are associated with multiple physical and mental health outcomes. Several proposed pathways of action for these benefits (e.g., stress reduction and attention restoration) require visual perception of green space; however, existing green space exposure measures commonly used in epidemiological studies do not capture street-scale exposures. We downloaded 254 Google Street View (GSV) panorama images from Portland, Oregon and calculated percent of green in each image, called Green View Index (GVI). For these locations we also calculated satellite-based normalized difference vegetation index (NDVI), % tree cover, % green space, % street tree buffering, distance to parks, and several neighborhood socio-economic variables. Correlations between the GVI and other green space measures were low (-0.02 to 0.50), suggesting GSV-based measures captured unique information about green space exposures. We further developed a GVI:NDVI ratio, which was associated with the amount of vertical green space in an image. The GVI and GVI:NDVI ratio were weakly related to neighborhood socioeconomic status and are therefore less susceptible to confounding in health studies compared to other green space measures. GSV measures captured unique characteristics of the green space environment and offer a new approach to examine green space and health associations in epidemiological research.

January 29 | 2018

Human Health Risk Assessment for Gasoline Exhaust

Prepared by: Fuels Assessment Section Water and Air Quality Bureau Healthy Environments and Consumer Safety Branch Health Canada November 2017


Excerpt from Executive Summary

Gasoline, or spark ignition, engines are used throughout Canada, representing 92% of on-road vehicles and 87% of off-road engines or equipment. It is reasonable to assume that exposure to gasoline engine exhaust (GE) is nearly ubiquitous, particularly for Canadians living in urban areas or in close proximity to a major roadway: it is estimated that approximately 2 million people live within 50 m of a major road in Canada. GE is a highly variable and complex mixture of particulate and gaseous pollutants, the composition of which depends on numerous factors, including fuel quality, engine and pollution control technologies, vehicle operating conditions and ambient temperature. GE is an important source of criteria air contaminants (CACs) associated with adverse effects on human health, including fine particulate matter (PM2.5), ground-level ozone (O3), nitrogen dioxide (NO2), volatile organic compounds (VOCs) and carbon monoxide (CO). In addition, GE constituents include air toxics that are recognized internationally as carcinogens, such as benzene and polycyclic aromatic hydrocarbons (PAHs).

Gasoline fuel, vehicles and engines are subject to multiple federal regulations that have successfully reduced air pollutant emissions from gasoline mobile sources, representing a major success in the management of air quality in Canada and the protection of human health. However, given the number of vehicles and engines in use, the age structure of the in-use fleets, and the vehicle kilometres travelled by Canadians, gasoline engines remain a key source of air pollution. The adverse health effects of individual pollutants in GE or produced secondarily in the atmosphere from primary GE emissions (e.g. PM2.5, O3, NO2, benzene and PAHs), are well characterized in the scientific literature and include increased risk of cardiorespiratory mortality and morbidity and of cancer, among other outcomes.

This report is a comprehensive review and analysis of the potential adverse health effects associated with gasoline fuel use in Canada. Two distinct approaches are used. Part A provides an evaluation of scientific studies that have examined the health effects associated with exposure to GE as a mixture. Studies on the health effects of individual GE constituents, such as PM2.5 and benzene, were not considered, as these substances have been extensively reviewed by Health Canada elsewhere. Part B provides a quantitative assessment of the contribution of on-road and off-road gasoline mobile source emissions to individual air pollutant concentrations in Canada and the population health impacts associated with that incremental contribution. The health impact analysis in Part B, which is based on well-established quantitative estimates of risk of adverse health impacts associated with incremental changes in air concentrations of individual pollutants, is complementary to the traditional risk assessment approach presented in Part A.

Measuring Walkability and Urban Sprawl – Opportunities and Challenges | February 28th 2018 | | REGISTER NOW

February 28 | 2018

9am – 10am pacific | 12 noon – 1pm eastern



The rise of physical inactivity and associated chronic health conditions (e.g., diabetes, cardiovascular disease) are a national challenge for Canada, both in terms of costs to healthcare systems and human suffering. This burden has prompted interest improving the active living friendliness (e.g., walkability) of Canadian communities to support daily physical activity as a population-level health intervention.

While many datasets and studies offer local perspectives on the human, health and economic impact of active living environments, national-level data is sparse. This webinar will discuss the potential of national indices recently developed by CANUE members as well as challenges for their use to study associations with health outcomes.



Dr. Dan Fuller and Dr. Henry Luan

Drs. Fuller and Luan will discuss the highlights from the November 2017 Walkability Workshop and provide an update on directions and research plans for the CANUE Neighbourhood Factors team in 2018.  They will provide an update of the upcoming Canadian urban sprawl and urban density measures being developed for CANUE. The presentation will focus on the development process and challenges with creating urban sprawl and density metrics.

Dr. Nancy Ross and Thomas Hermann

Introducing Can-ALE – the new Canadian Active Living Environment Index. Can-ALE is a recently released dataset of geographic-based active living friendliness measures for Canada. Hear about the work undertaken to produce the dataset, findings that may inform future data creation activities, and potential uses for research and policy.


Daniel Fuller is Canada Research Chair in Population Physical Activity in the School of Human Kinetics and Recreation at Memorial University. His research is focused on using wearable technologies to study physical activity, transportation interventions, and equity in urban spaces. He focuses his methodological work on methods for natural experiments, and machine learning.



Hui (Henry) Luan is a post-doctoral fellow in the School of Human Kinetics and Recreation at Memorial University. His research focuses on spatial and spatio-temporal modeling of health-related phenomena using Bayesian approaches. The main aim is to detect spatial and spatio-temporal clusters of these phenomena and identify risk factors that contribute to the geographical disparities.



Nancy Ross is a Professor in the Department of Geography, associate member of the Department of Epidemiology and Biostatistics, the Institute for Health and Social Policy, and the School of Environment, Associate Vice-Principal of Research and Innovation at McGill University and is a Canada Research Chair.  Her research interests include how social and built environments affect human health. She currently oversees a broad range of research, including studies which analyze the relationship between neighbourhood-level built design, food environments and health outcomes.


Thomas Herrmann is a research assistant and recent graduate of McGill University (BA Geography). Over the past year, Thomas was involved with the creation of Can-ALE, a national database of GIS-derived measures of the active living friendliness of Canadian communities. Presently, his work centres on analyzing the relationship between characteristics of the built environment and population health through data linkage with national health surveys.

Travel Awards for CPHA | Montreal May 2018

Post-doctoral, graduate and undergraduate students who are developing data for CANUE, or who have used our data to produce new research are eligible to apply for a student travel award.

We will provide up to $1,250 toward the cost of travel, hotel, and registration fees for selected events. Applications will be reviewed by a Committee of CANUE members.

The Canadian Public Health Association Annual Meeting  May 26-30, 2018 | Montreal, Ontario

Postdoctoral Fellowship – Apply by Feb 28th | 2018

Subject: Postdoctoral Fellowship in Exposure Science/Environmental modeling

Where: One of the following Canadian cities of the members of the noise team of the Canadian Urban Environmental Health Consortium: Montreal, Toronto, Halifax, Vancouver.

Terms: The start date of the position is flexible, but ideally the position would be filled by April 2018. The fellow will receive at least 50,000$CAN per year (plus benefits).

Description: a 2-year fellowship (1-year renewable) is available as part of CANUE for the development of a national land use regression model for noise, based on measurements and predictor variables assembled by CANUE. The postdoctoral fellow will also be involved in other activities of the noise team such as in the development of a noise propagation model for Canadian cities. To develop these models, the postdoctoral fellow will perform data management and analysis, disseminate research findings through manuscript authorship and present findings at professional meetings; it is anticipated that the candidate may also be involved in fieldwork measurement campaigns.

Qualifications: Applicants must possess a PhD in a relevant area (e.g. geography, environmental sciences, engineering, or other relevant areas) and have less than 3 years of prior post-doctoral experience. Candidates must have strong skills in both quantitative analysis and writing.

Interested applicants should submit an application, in one PDF document, that includes a statement of interest and curriculum vitae with the name of two referees, to info@canue.ca.

Travel Awards for ISES/ISEE – Apply by April 15th | 2018

The CANUE Board of Directors prioritizes supporting travel to selected conferences in accordance with our Strategic Plan.

Post-doctoral, graduate and undergraduate students who are developing data for CANUE, or who have used our data to produce new research are eligible to apply for a student travel award.

We will provide up to $1,250 toward the cost of travel, hotel, and registration fees for selected events. Applications will be reviewed by a Committee of CANUE members.

The International Association of Exposure Science & the International Association for Environmental Epidemiology combined annual meeting  August 26-30, 2018 | Ottawa, Ontario

Twelve awards now available: apply by April 15th, 2018

January 15 | 2018

The Canadian Urban Environmental Health Research Consortium – a protocol for building a national environmental exposure data platform for integrated analyses of urban form and health

Jeffrey R. Brook, Eleanor M. Setton, Evan Seed, Mahdi Shooshtari, Dany Doiron and CANUE – The Canadian Urban Environmental Health Research Consortium

BMC Public Health BMC series https://doi.org/10.1186/s12889-017-5001-5 Published: 8 January 2018



Multiple external environmental exposures related to residential location and urban form including, air pollutants, noise, greenness, and walkability have been linked to health impacts or benefits. The Canadian Urban Environmental Health Research Consortium (CANUE) was established to facilitate the linkage of extensive geospatial exposure data to existing Canadian cohorts and administrative health data holdings. We hypothesize that this linkage will enable investigators to test a variety of their own hypotheses related to the interdependent associations of built environment features with diverse health outcomes encompassed by the cohorts and administrative data.

January 8 | 2018

Respiratory and cardiovascular responses to walking down a traffic-polluted road compared with walking in a traffic-free area in participants aged 60 years and older with chronic lung or heart disease and age-matched healthy controls: a randomised, crossover study

Rudy Sinharay, MBBS, Jicheng Gong, PhD, Benjamin Barratt, PhD, Pamela Ohman-Strickland, PhD, Sabine Ernst, MD, Prof Frank Kelly, PhD, Prof Junfeng (Jim) Zhang, PhD, Prof Peter Collins, MD, Prof Paul Cullinan, MD, Prof Kian Fan Chung, DSc

Co-first authors contributed equally

The Lancet.  DOI: http://dx.doi.org/10.1016/S0140-6736(17)32643-0 Published: 05 December 2017


Long-term exposure to pollution can lead to an increase in the rate of decline of lung function, especially in older individuals and in those with chronic obstructive pulmonary disease (COPD), whereas shorter-term exposure at higher pollution levels has been implicated in causing excess deaths from ischaemic heart disease and exacerbations of COPD. We aimed to assess the effects on respiratory and cardiovascular responses of walking down a busy street with high levels of pollution compared with walking in a traffic-free area with lower pollution levels in older adults.