Purpose:  Reliance on cars contributes to physical inactivity, and therefore may be a risk factor for type 2 diabetes. We investigated whether living in neighborhoods that are highly conducive to driving is associated with an increased incidence of diabetes.

Methods: Working age adults (20-64 yrs) who were living in Toronto, Canada on April 1^st 2011, were followed over 6 yrs for incident diabetes using a validated algorithm based on hospital records and physicians’ services claims. For neighborhood drivability, we used a novel index capturing three factors of the built environment: urban sprawl, pedestrian unfriendliness and parking options. Cox regression was used to examine the association between neighborhood drivability quintiles (Q) and diabetes incidence, adjusting for age, sex, income, ethnicity, immigration status and comorbidity, and censoring for death.

Results: Among 1,473,994 individuals in our sample (mean age 40.9±12.2, 48.5% male), 77,835 developed diabetes. Overall, there was a direct relationship between drivability and diabetes incidence, however the magnitude of this effect varied by age and income. Among young adults (20-34 yrs), those living in the most drivable neighborhoods (Q5) had a 58% higher incidence of diabetes (adjusted HR: 1.58 (95%CI: 1.47-1.69)) relative to those in the least drivable neighborhoods (Q1), whereas the same comparison in older adults (55-64 yrs) yielded smaller differences (HR: 1.31 (95%CI: 1.26-1.36)). High drivability was most strongly associated with diabetes risk in the middle income neighborhoods with 96% increased risk for young residents (HR:1.96 (95%CI: 1.64-2.33) and a 46% increased risk for older residents (HR: 1.46 (95%CI:1.32-1.62). Associations between drivability and diabetes incidence were significant but of a lesser magnitude in low- and high-income neighborhoods.

Conclusion: In our setting, neighborhood drivability is a risk factor for the diabetes incidence among working age adults, especially younger, middle-income populations.

Purpose: Replacement of car ownership by car sharing can have multiple positive effects, including increased use of active modii (walking, cycling), reduced vehicle miles travelled, and increased liveability of cities. Less is known on how car sharing can be encouraged. The aims of this study are: 1) to explore views on car sharing among car owners and non-car owners, and 2) to investigate whether the introduction of a shared mobility hub in a neighbourhood contributes to changes in attitudes, intentions and transport behaviours.

Methods: A mixed methods design was employed. Participants were adults residing within 1km from a ‘shared mobility hub’ (i.e. a hub with different types of cars available for sharing, located in a central parking space), which opened on January 31st 2020 in a residential neighbourhood in Utrecht, the Netherlands. We conducted a baseline survey in January 2020 (n=227), semi-structured qualitative interviews in April-June 2020 (n=24), and a follow-up survey in September 2020 (n=84). Qualitative interviews were recorded, transcribed verbatim and analysed following a grounded theory approach using NVivo software. Survey data were analysed in SPSS.

Results: Important themes during the interviews were: irrational and emotional arguments for car ownership and car sharing; the need for a wide range of cars (brands, sizes) to choose from; shared cars as replacement for travelling by bike or public transport; contribution of the shared mobility hub to community connectiveness. Views differed largely between car owners and non-car owners, which was also confirmed by the survey data. Intention to use the shared mobility hub at baseline was much higher among non-car owners (71%) than car owners (38%). Observed changes in attitudes, intentions and behaviours between baseline and follow-up were likely influenced by the Covid-19 pandemic and lockdown.

Conclusions: In a compact Dutch city with good public transport and high cycling levels, the introduction of a shared mobility hub can have positive effects (e.g. more positive attitudes towards car sharing, increased community connectedness), but also unwanted effects (e.g. biking and public transport trips being replaced by car sharing). It is therefore important to evaluate policies to encourage car sharing from a systems perspective.