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14 pages, 856 KB  
Article
Leisure Participation of Taiwanese Families Raising Children with Developmental Delays and Disabilities
by Ya-Jung Lin
Children 2025, 12(10), 1326; https://doi.org/10.3390/children12101326 - 2 Oct 2025
Viewed by 211
Abstract
Background/Objectives: Leisure participation is vital for children’s development and family inclusion, yet families of children with developmental delays and disabilities face significant barriers. Guided by a health literacy framework, this study examined how personal and organizational health literacy shape access to inclusive leisure [...] Read more.
Background/Objectives: Leisure participation is vital for children’s development and family inclusion, yet families of children with developmental delays and disabilities face significant barriers. Guided by a health literacy framework, this study examined how personal and organizational health literacy shape access to inclusive leisure opportunities. Methods: Semi-structured interviews were conducted with 14 caregivers of young children (aged 2 to 6 years) with developmental delays and disabilities. A qualitative content analysis was applied to identify family and environmental factors shaping leisure participation. Results: Families with stronger personal health literacy engaged in diverse leisure activities, prioritizing children’s development through park visits and structured home routines. In contrast, weak organizational health literacy—reflected in limited inclusive facilities and support systems—restricted opportunities, increased caregiver stress, and forced adaptations such as traveling farther or rescheduling activities. These barriers underscored families’ vulnerability to exclusion while also highlighting their resilience in navigating daily life. Conclusions: This study demonstrates that health literacy functions at both personal and organizational levels to shape leisure participation. Beyond identifying barriers, it shows that leisure is intertwined with developmental needs and school readiness. By applying a health literacy lens, the study contributes to understanding family dynamics in inclusive leisure and underscores the need for responsive community services and inclusive policies. Full article
(This article belongs to the Special Issue Parenting a Child with Disabilities)
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20 pages, 9060 KB  
Article
The 15-MinuteCampus: Exploring the Potential Impacts on Biodiversity, Health and Wellbeing of Co-Creating 15-Minute City Design Principles on University Campuses
by Rachel Sara, Alex Albans and Louis Rice
Architecture 2025, 5(3), 82; https://doi.org/10.3390/architecture5030082 - 10 Sep 2025
Viewed by 447
Abstract
Imagine picking up an e-scooter or e-bike from a charging dock on campus that combines solar panels with a filtered rainwater refill fountain, a mobile phone charging point, climbing plants, and insect habitats. What if the space also offered composting for food waste, [...] Read more.
Imagine picking up an e-scooter or e-bike from a charging dock on campus that combines solar panels with a filtered rainwater refill fountain, a mobile phone charging point, climbing plants, and insect habitats. What if the space also offered composting for food waste, shelter from the rain, and a space to meet friends—open to all to support the university’s civic role in the wider city? This paper explores the ideas affecting biodiversity, health, and wellbeing of co-created design explorations of 15-minute city principles on university campuses. Originating from urban planning, the 15-minute city proposes that essential needs like education, healthcare, work, and leisure are accessible by active travel. Applied to a university campus, it means students and staff can access classrooms, housing, food, and recreation in just 15 minutes. Beyond convenience, this approach is argued to foster inclusive, mixed-use, and potentially ecologically regenerative spaces. Drawing on regenerative design thinking—which aims to restore and co-evolve human and natural systems—this participatory design research critically responds to top-down models by involving students and university stakeholders in co-creating visions for a 15-minute campus. The results show that through this participatory design process, cocreators contributed to shaping ideas that foster belonging, emotional attachment, and co-responsibility for place. The research concludes by proposing an innovative reorientation of the 15-minute-city—from a model concerned primarily with needs and efficiency, to one grounded in ecological consciousness, autonomy, and human–nature co-evolution. Full article
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11 pages, 676 KB  
Perspective
Tailoring In-Flight Food Consumption to Alleviate Fear of Flying Through Sensory Stimulation
by Francesco Sansone, Francesca Gorini, Alessandro Tonacci and Francesca Venturi
Appl. Sci. 2025, 15(14), 8057; https://doi.org/10.3390/app15148057 - 19 Jul 2025
Viewed by 600
Abstract
Nowadays, society is becoming increasingly committed to traveling by plane for work, tourism, and leisure in general. However, either due to internal, specific factors or to external determinants, like terrorism and climate changes, a growing number of travelers have experienced the so-called fear [...] Read more.
Nowadays, society is becoming increasingly committed to traveling by plane for work, tourism, and leisure in general. However, either due to internal, specific factors or to external determinants, like terrorism and climate changes, a growing number of travelers have experienced the so-called fear of flying, a persistent, irrational fear of flight-related situations for which a clear, efficacious therapy does not yet exist. Based on the usual interaction with the surrounding environment, conducted by means of the five human senses, and particularly on the neurophysiological pathway followed by the chemical senses, in this study, we revise the findings in the related literature on the topic, proposing an alternative way to alleviate the anxiety related to the fear of flight. This is based on chemosensory stimulation being applied directly during a flight and is possibly concerned with the consumption of meals, an usual activity performed onboard. After an introductory section aimed at understanding the problem, we present some studies related to chemosensory perception during the flight, highlighting the specificities of the scenarios, followed by a description of findings related to the meals proposed by flight companies in this context, and finally wrapping up the possible alternative approaches that could be conducted by such providers to alleviate the fear of flying condition through chemosensory stimulation vehiculated by meals, and enhance the quality of flight experience related to food consumption onboard. Full article
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20 pages, 671 KB  
Article
Digital Natives on the Move: Cross-Cultural Insights into Generation Z’s Travel Preferences
by Ioana-Simona Ivasciuc, Arminda Sá Sequeira, Lori Brown, Ana Ispas and Olivier Peyré
Sustainability 2025, 17(14), 6601; https://doi.org/10.3390/su17146601 - 19 Jul 2025
Viewed by 2924
Abstract
Generation Z (Gen Z; born 1997–2012) is reshaping global tourism through digital fluency, ethical awareness, and a desire for authentic, sustainable travel experiences. This study surveys 413 Gen Z travelers across France, Portugal, Romania, and the USA to map their booking behaviors, information [...] Read more.
Generation Z (Gen Z; born 1997–2012) is reshaping global tourism through digital fluency, ethical awareness, and a desire for authentic, sustainable travel experiences. This study surveys 413 Gen Z travelers across France, Portugal, Romania, and the USA to map their booking behaviors, information sources, transport modes, accommodations, dining practices, and leisure activities. The findings reveal a strong preference for independent online bookings and social-media-influenced destination choices (Instagram, TikTok), with air and car travel being used for long-distance journeys and walking/public transit being used for local journeys. Accommodation spans commercial hotels and private rentals, while informal, local dining and nature- or culture-centered leisure prevail. Chi-square tests were performed to identify differences between countries. To reveal distinct traveler segments and their country’s modulations towards sustainability, a hierarchical cluster analysis was performed. The results uncover four segments: “Tech-Active, Nature-Oriented Minimalists” (32.3% in France); “Moderate Digital Planners” (most frequent across all countries, particularly dominant among Romanian respondents); “Disengaged and Indecisive Travelers” (overrepresented in the USA); and “Culturally Inclined, Selective Sustainability Seekers” (>30% in France/Portugal). Although sustainability is widely valued, only some segments of the studied population consistently act on these values. The results suggest that engaging Gen Z requires targeted, value-driven digital strategies that align platform design with the cohort’s diverse sustainability commitments. Full article
(This article belongs to the Special Issue Sustainable Tourism Management and Marketing)
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39 pages, 3160 KB  
Review
Sustainable Mobility and Shared Autonomous Vehicles: A Systematic Literature Review of Travel Behavior Impacts
by Alessandro La Delfa and Zheng Han
Sustainability 2025, 17(7), 3092; https://doi.org/10.3390/su17073092 - 31 Mar 2025
Cited by 5 | Viewed by 2435
Abstract
Shared autonomous vehicles (SAVs) are emerging as a potential tool for sustainable transportation, yet their impact on travel behavior and environmental outcomes remains uncertain. This review evaluates the sustainability implications of SAV adoption, including its potential to reduce emissions through optimized fleet operations, [...] Read more.
Shared autonomous vehicles (SAVs) are emerging as a potential tool for sustainable transportation, yet their impact on travel behavior and environmental outcomes remains uncertain. This review evaluates the sustainability implications of SAV adoption, including its potential to reduce emissions through optimized fleet operations, enhance social equity by improving mobility access, and increase economic efficiency through resource-sharing models. This systematic literature review examines 107 articles from English and Chinese databases, focusing on SAVs’ effects on total travel demand, mode choice, and in-vehicle time use. Findings indicate that SAVs could increase vehicle miles traveled due to unoccupied relocation and new demand from previously underserved demographics, though advanced booking and dispatch systems may mitigate this increase. The study identifies 59 factors influencing SAV adoption, categorized as user-centric, contextual, and psycho-attitudinal. Analysis of in-vehicle time use shows varied activities, from productivity to leisure, with contradictory findings in the value of travel time (VOT) compared to conventional vehicles: while some studies report up to 34% lower VOT for SAVs due to multitasking opportunities, others find up to 29% higher VOT. Privacy and personal space emerge as important factors, with users showing a high willingness to pay to avoid additional passengers. The review highlights underexplored variables and methodological limitations in current research, including psychological influences and mode substitution dynamics. These insights inform policymakers and urban planners on how to integrate SAVs into sustainable transportation systems by mitigating their environmental impact, promoting equitable access, and ensuring alignment with smart urban planning strategies. Full article
(This article belongs to the Section Sustainable Transportation)
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21 pages, 2497 KB  
Article
On the Use of a Bike-Sharing System in Extreme Weather Events: The Case of Porto Alegre, Rio Grande do Sul, Brazil
by Kayck de Araújo, Luciana Lima, Mariana Andreotti Dias, Daniel G. Costa and Ivanovitch Silva
Sustainability 2025, 17(5), 2291; https://doi.org/10.3390/su17052291 - 6 Mar 2025
Viewed by 2085
Abstract
This article aims to analyze the use of a bike-sharing system (BSS) during the flooding event caused by extreme rainfall that hit the municipality of Porto Alegre, Brazil, in May 2024. Public transport services were interrupted, prompting an investigation into the resilience of [...] Read more.
This article aims to analyze the use of a bike-sharing system (BSS) during the flooding event caused by extreme rainfall that hit the municipality of Porto Alegre, Brazil, in May 2024. Public transport services were interrupted, prompting an investigation into the resilience of the BSS during the crisis. Considering data from the Tembici BSS company, a set of approximately 400,000 trips made between 104 stations in the municipality of Porto Alegre from January to May 2024 were analyzed. Daily rainfall data from the National Institute of Meteorology (INMET) were compared with the daily trip flow to identify the travel flow patterns on the days most affected by the flooding. The results indicate an abrupt drop in shared bicycle use during May 2024, but 7600 trips were recorded despite the crisis. Regarding the travel pattern between 1 May and 10 May, most trips were still for recreational purposes (73%), while trips for work and study accounted for 22% of the total, and only 5% were for delivery services. Overall, the resilience of the BSS during the extreme climate event in question points to the continuation of practical daily activities, although with more significant effects on economic-related activities and lesser effects on leisure-related activities. Full article
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20 pages, 3364 KB  
Article
Optimized Travel Itineraries: Combining Mandatory Visits and Personalized Activities
by Parida Jewpanya, Pinit Nuangpirom, Siwasit Pitjamit and Warisa Nakkiew
Algorithms 2025, 18(2), 110; https://doi.org/10.3390/a18020110 - 17 Feb 2025
Cited by 1 | Viewed by 2170
Abstract
Tourism refers to the activity of traveling for pleasure, recreation, or leisure purposes. It encompasses a wide range of activities and experiences, from sightseeing to cultural exploration. In today’s digital age, tourists often organize their excursions independently by utilizing information available on websites. [...] Read more.
Tourism refers to the activity of traveling for pleasure, recreation, or leisure purposes. It encompasses a wide range of activities and experiences, from sightseeing to cultural exploration. In today’s digital age, tourists often organize their excursions independently by utilizing information available on websites. However, due to constraints in designing customized tour routes such as travel time and budget, many still require assistance with vacation planning to optimize their experiences. Therefore, this paper proposes an algorithm for personalized tourism planning that considers tourists’ preferences. For instance, the algorithm can recommend places to visit and suggest activities based on tourist requirements. The proposed algorithm utilizes an extended model of the team orienteering problem with time windows (TOPTW) to account for mandatory locations and activities at each site. It offers trip planning that includes a set of locations and activities designed to maximize the overall score accumulated from visiting these locations. To solve the proposed model, the Adaptive Neighborhood Simulated Annealing (ANSA) algorithm is applied. ANSA is an enhanced version of the well-known Simulated Annealing algorithm (SA), providing an adaptive mechanism to manage the probability of selecting neighborhood moves during the SA search process. The computational results demonstrate that ANSA performs well in solving benchmark problems. Furthermore, a real-world attractive location in Tak Province, Thailand, is used as the case study in this paper to illustrate the effectiveness of the proposed model. Full article
(This article belongs to the Section Algorithms for Multidisciplinary Applications)
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28 pages, 5061 KB  
Article
Does Higher Exposure to Green Spaces Lead to Higher Life Satisfaction and Less Leisure Travel? A Case Study of Reykjavík, Iceland
by Johanna Raudsepp, Kamyar Hasanzadeh, Áróra Árnadóttir, Jukka Heinonen and Michał Czepkiewicz
Urban Sci. 2024, 8(4), 236; https://doi.org/10.3390/urbansci8040236 - 2 Dec 2024
Viewed by 1843
Abstract
Urban areas have a significant impact on climate change, with transport and mobility as one major source. Furthermore, the impact of urban areas on transport extends beyond their own geographic areas, via leisure travel. Research has suggested several mechanisms through which urban areas [...] Read more.
Urban areas have a significant impact on climate change, with transport and mobility as one major source. Furthermore, the impact of urban areas on transport extends beyond their own geographic areas, via leisure travel. Research has suggested several mechanisms through which urban areas drive leisure travel, such as social norms, compensation for what is lacking in the urban environment or for the hectic daily life, and cosmopolitan attitudes, all of which increase leisure travel for its expected wellbeing benefits. More research is needed, however, about how the daily exposure to the urban environment affects leisure travel activity and how perceived wellbeing is associated with this. Therefore, this study was set to examine data from a 2017 softGIS survey from Reykjavík, Iceland, to study the connections between urban environment, local mobility, leisure travel, and life satisfaction. The study employs activity spaces as a basis for exposure modeling and canonical correlation analysis for statistical analysis. The results reveal that although exposure to green and gray spaces is important to overall life satisfaction, underlying socio-economic background is more relevant. Further, higher exposure to gray spaces was found to be associated with more emissions from long-distance leisure travel when socio-economic background was included, but it lost importance when attitudinal factors were added. Furthermore, indications of high levels of urban mobility leading to more leisure travel away from the city were found. Although overarching policy recommendations cannot be made, the study suggests having a more citizen-oriented approach in urban planning, particularly for mobility, which could yield benefits for both wellbeing and climate mitigation outcomes. Full article
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39 pages, 11225 KB  
Article
Decoding Jakarta Women’s Non-Working Travel-Mode Choice: Insights from Interpretable Machine-Learning Models
by Roosmayri Lovina Hermaputi and Chen Hua
Sustainability 2024, 16(19), 8454; https://doi.org/10.3390/su16198454 - 28 Sep 2024
Cited by 3 | Viewed by 1931
Abstract
Using survey data from three dwelling types in Jakarta, we examine how dwelling type, socioeconomic identity, and commuting distance affect women’s travel-mode choices and motivations behind women’s choices for nearby and distant non-working trips. We compared the performance of the multinomial logit (MNL) [...] Read more.
Using survey data from three dwelling types in Jakarta, we examine how dwelling type, socioeconomic identity, and commuting distance affect women’s travel-mode choices and motivations behind women’s choices for nearby and distant non-working trips. We compared the performance of the multinomial logit (MNL) model with two machine-learning classifiers, random forest (RF) and XGBoost, using Shapley additive explanations (SHAP) for interpretation. The models’ efficacy varies across different datasets, with XGBoost mostly outperforming other models. The women’s preferred commuting modes varied by dwelling type and trip purpose, but their motives for choosing the nearest activity were similar. Over half of the women rely on private motorized vehicles, with women living in the gated community heavily relying on private cars. For nearby shopping trips, low income and young age discourage women in urban villages (kampungs) and apartment complexes from walking. Women living in gated communities often choose private cars to fulfill household responsibilities, enabling them to access distant options. For nearby leisure, longer commutes discourage walking except for residents of apartment complexes. Car ownership and household responsibilities increase private car use for distant options. SHAP analysis offers practitioners insights into identifying key variables affecting travel-mode choice to design effective targeted interventions that address women’s mobility needs. Full article
(This article belongs to the Special Issue Sustainable Traffic and Mobility)
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19 pages, 3336 KB  
Review
Gaining Traction on Social Aspects of E-Biking: A Scoping Review
by Allison McCurdy, Elizabeth E. Perry, Jessica E. Leahy, Kimberly J. Coleman, Joshua Doyle, Lydia A. Kiewra, Shelby A. Marocco, Tatiana A. Iretskaia, Madison M. Janes and Mikael Deliyski
Sustainability 2024, 16(17), 7397; https://doi.org/10.3390/su16177397 - 28 Aug 2024
Cited by 2 | Viewed by 3627
Abstract
E-biking is alluring for its various physical, environmental, and financial benefits and the ability to travel farther and faster, and being physically easier to ride than astride an analog (traditional) bicycle. E-bikes are also a source of controversy, especially in places where analog [...] Read more.
E-biking is alluring for its various physical, environmental, and financial benefits and the ability to travel farther and faster, and being physically easier to ride than astride an analog (traditional) bicycle. E-bikes are also a source of controversy, especially in places where analog bicycles have been allowed but e-bikes represent a “slippery slope” of technology permissions and/or in situations where the function of e-bikes may increase concerns about safety. Despite an increase in use and conversation about such use, academic literature focused on e-bikes’ social aspects remains sparse. The objective of this work is to describe the existing literature on the characteristics of social aspects of e-biking, particularly in leisure contexts. Analyzing the literature on e-bike social research is crucial considering e-bikes’ rapid rise in popularity and potential effects on access, inclusion, leisure, and sustainability. As e-bike prevalence and use increases worldwide, it is important to understand what topics characterize the existing e-bike literature, and, particularly in leisure-focused studies, to ascertain where studies may lend insight toward aims of inclusive and sustainable access, and related policy considerations. The Integrated Recreation Amenities Framework (IRAF) provides a conceptual framework for considering this question, as it focuses on the topical, spatial, and temporal scales of outdoor leisure-related activities toward sustainable conditions and explicitly provides an opportunity for emergent and case-specific factors to be considered alongside established ones. In this work, we explore the following: (1) How are e-bikes discussed across disciplines? and (2) How are e-bikes discussed in leisure-focused articles? Using a scoping review approach, we analyzed a corpus of 279 peer-reviewed articles relevant to the social aspects of e-bikes. Primarily using the IRAF for conceptual framing, our results center the geographies and contexts, topical areas, interdisciplinarity, and emergent additional social considerations of e-biking in general and in leisure-specific studies. The results enable us to connect interdisciplinary topic discussions and suggest where foundational and connective studies are warranted. This can inform decision making related to e-bike adoption, encourage multi-scalar thinking, and extend interdisciplinary research. Full article
(This article belongs to the Special Issue Behavioural Approaches to Promoting Sustainable Transport Systems)
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20 pages, 3930 KB  
Article
Urban Physical Environments Promoting Active Leisure Travel: An Empirical Study Using Crowdsourced GPS Tracks and Geographic Big Data from Multiple Sources
by Yunwen Chen, Binhui Wang, Jing Huang, Hei Gao and Xianfan Shu
Land 2024, 13(5), 589; https://doi.org/10.3390/land13050589 - 28 Apr 2024
Cited by 5 | Viewed by 2382
Abstract
Specific environmental characteristics can encourage active leisure travel and increase physical activity. However, existing environment-travel studies tend to ignore the differences in environmental characteristics associated with route choice and travel distance, of which the latter could be more important for health benefits, since [...] Read more.
Specific environmental characteristics can encourage active leisure travel and increase physical activity. However, existing environment-travel studies tend to ignore the differences in environmental characteristics associated with route choice and travel distance, of which the latter could be more important for health benefits, since longer trips are associated with increased exercise. Additionally, the most recent studies focus on leisure walking and leisure cycling, and activities such as hiking, climbing, and running are examined less frequently. This study, therefore, compares the similarities and differences of the environmental factors associated with route selection and travel distance through non-parametric tests and Cox proportional hazard models. The results show that two intersecting sets of environmental elements relate to both the route chosen and the distance traveled. Land use diversity and varied topography are appealing for both leisure trips and trip length. In addition, the differences in environmental characteristics among specific leisure travels may be attributed to variations in physical activity requirements, preferences for landscape viewing, and/or sensitivity to crowding. Therefore, conclusions drawn without considering the different types of leisure travel could be skewed. Whether particular surroundings may effectively increase physical activity remains uncertain. A more holistic perspective could be beneficial when studying the connection between the environment, active travel, and health. Full article
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13 pages, 987 KB  
Article
Exploring the Relationship of Leisure Travel with Loneliness, Depression, and Cognitive Function in Older Adults
by Shu Cole, Chenggang Hua, Siyun Peng and Weixuan Wang
Int. J. Environ. Res. Public Health 2024, 21(4), 498; https://doi.org/10.3390/ijerph21040498 - 18 Apr 2024
Cited by 5 | Viewed by 3519
Abstract
Loneliness, depression, and cognitive decline are pressing concerns among older adults. This study examines the association between leisure travel participation and these health outcomes in older adults, aiming to provide further evidence of the benefits of leisure travel. Using nationally representative historical data [...] Read more.
Loneliness, depression, and cognitive decline are pressing concerns among older adults. This study examines the association between leisure travel participation and these health outcomes in older adults, aiming to provide further evidence of the benefits of leisure travel. Using nationally representative historical data from the 2006 household survey of the Health and Retirement Study, this study conducted a series of regression analyses to investigate the relationship between traveling and the three health outcomes, adjusting for age, sex, race, marital status, education, total wealth, annual income, and difficulty with daily activities. The results reveal that travel patterns in terms of distance are significantly associated with loneliness, depression, and cognitive function. Long-distance travel is positively related to higher cognitive function and a reduction in depressive symptoms, along with lower levels of loneliness, reinforcing the notion that leisure travel can potentially act as a catalyst for improved cognitive and mental health by offering opportunities for enhancing social connections and forming new relationships. The findings on the relationships between participation in leisure travel and mental and cognitive health contribute to the body of evidence supporting the therapeutic value of leisure travel in promoting healthy aging and enhancing the overall well-being in older adults. Full article
(This article belongs to the Special Issue Travel, Health, and Wellness of Older Adults)
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14 pages, 1150 KB  
Article
Everyday Activities of Older Adults in Tianjin, China: Coupling Constraints, Gendered Mobilities and Social Context
by Yaqian Mao and Tomoko Kubo
Behav. Sci. 2023, 13(12), 996; https://doi.org/10.3390/bs13120996 - 4 Dec 2023
Cited by 3 | Viewed by 2508
Abstract
Many Western studies have indicated that older women are generally more vulnerable in terms of mobility compared to older men, particularly regarding driving. However, the situation may differ in the context of China. This study, based on activity diaries and semi-structured interviews, focuses [...] Read more.
Many Western studies have indicated that older women are generally more vulnerable in terms of mobility compared to older men, particularly regarding driving. However, the situation may differ in the context of China. This study, based on activity diaries and semi-structured interviews, focuses on the spatiotemporal behavior of older adults in Tianjin and explores how the constraints posed by activity companions (in terms of type, size, and composition) shape the mobilities of older men and women, including activity locations, travel distances, and transportation modes. The key findings are as follows: First, older women are more engaged with their families due to a higher percentage and longer duration of activities spent with family members. Second, older men tend to have more concentrated travel distances near their homes compared to older women. Third, older women exhibit a broader range of activities in different locations and engage in longer-distance leisure travel with family members when compared to older men. In the context of Western literature, this study discusses older women’s enhanced social interactions, their earlier retirement in China, and the impact of COVID-19 as factors that help explain these findings. This study contributes to a deeper understanding of accompanied mobilities among Chinese older adults using geographical theory and methods, emphasizing the importance of flexible work schedules for the workforce and the organization of community-based activities to promote the social interactions and mobilities of older adults. Full article
(This article belongs to the Special Issue Aging in Place: The Role of Housing and Social Supports)
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13 pages, 624 KB  
Article
Improving Mobility in Marginalised Communities
by Charles Musselwhite
Future Transp. 2023, 3(4), 1347-1359; https://doi.org/10.3390/futuretransp3040074 - 1 Dec 2023
Cited by 6 | Viewed by 2664
Abstract
This paper examines how mobility can be re-examined within four communities that face substantial transport barriers. Four case study communities facing mobility exclusion were investigated: (i) an ageing community in South Wales; (ii) a community of people with learning difficulties from across Wales; [...] Read more.
This paper examines how mobility can be re-examined within four communities that face substantial transport barriers. Four case study communities facing mobility exclusion were investigated: (i) an ageing community in South Wales; (ii) a community of people with learning difficulties from across Wales; (iii) female university students in Pakistan; (iv) a deprived neighbourhood in mid-Wales. Using an illuminative evaluation, collating a variety of information from documents associated with the communities, it was identified that transport creates freedom, independence, and contributes to sense of purpose, worth, and can help create community. Barriers to public transport include inaccessibility of the first/last mile, services not running at required times, being delayed, and cancelled. Barriers to active travel include poor infrastructure. Not being able to be mobile affects health, not just with a lack of active travel but also missed health appointments and a lack of access to healthy foods. Already marginalised communities are further disadvantaged by the barriers reducing access to jobs, education, services, shops, and leisure. Communities want support to develop their knowledge into a package that actors can use to develop a solution, often citing the need for quantitative skills, however, other ways of utilising experiential knowledge might be more appropriate. Full article
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15 pages, 785 KB  
Article
Financial Toxicity in Swiss Cancer Patients Treated with Proton Therapy: An Observational Cross-Sectional Study on Self-Reported Outcome
by Barbara Bachtiary, Leonie Grawehr, Filippo Grillo Ruggieri, Ulrike Held and Damien C. Weber
Cancers 2023, 15(23), 5498; https://doi.org/10.3390/cancers15235498 - 21 Nov 2023
Cited by 3 | Viewed by 1915
Abstract
Background: Proton therapy is indicated for cancers that would be difficult to treat with conventional radiotherapy. Compulsory healthcare insurance covers the costs of this therapy in Switzerland, but this does not mean that proton therapy is cost-neutral for every cancer patient. Significant out-of-pocket [...] Read more.
Background: Proton therapy is indicated for cancers that would be difficult to treat with conventional radiotherapy. Compulsory healthcare insurance covers the costs of this therapy in Switzerland, but this does not mean that proton therapy is cost-neutral for every cancer patient. Significant out-of-pocket (OOP) costs may arise due to expenses associated with proton therapy, and patients may experience treatment-related financial distress—an effect known as “financial toxicity.” This study investigates the financial toxicity of patients undergoing proton therapy in a high-income country with a compulsory health insurance policy. Methods: Between September 2019 and November 2021, 146 Swiss cancer patients treated with proton therapy participated in this study, of whom 90 (62%) were adults and 56 (38%) were caregivers of child cancer patients. Financial toxicity was assessed using the FACIT Comprehensive Score for Financial Toxicity (COST). OOP costs during proton therapy were recorded weekly, and financial coping strategies were captured at the end of treatment. Findings: The median COST score, indicating financial toxicity, was 29.9 (IQR 21.0; 36.0) for all patients, 30.0 (IQR 21.3; 37.9) for adults, and 28.0 (IQR 20.5; 34.0) for children’s caregivers. Higher income (estimate 8.1, 95% CI 3.7 to 12.4, p ≤ 0.001) was significantly associated with higher COST scores, indicating less financial toxicity. Further distance from home to the treatment centre per 100 km (estimate −3.7, 95% CI −5.7 to −1.9, p ≤ 0.001) was significantly associated with lower COST scores, indicating increased financial toxicity. Married adult patients had substantially lower COST scores than single patients (estimate: −9.1, 95% CI −14.8 to −3.4, p ≤ 0.001). The median OOP cost was 2050 Swiss francs (CHF) and was spent mainly on travel, accommodation, and eating out. Sixty-three (43%) patients used their savings; 54 (37%) cut spending on leisure activities; 21 (14.4%) cut living expenses; 14 (9.6%) borrowed money; nine (6.2%) worked more; and four (2.7%) sold property. Patients with high COST scores used significantly fewer coping strategies such as saving on leisure activities (estimate −9.5, 95% CI −12.4 to −6.6, p ≤ 0.001), spending savings (estimate −3.9, 95% CI −6.3 to −1.4, p = 0.002), borrowing money (estimate −6.3, 95% CI −10.4 to −2.2, p = 0.003), and increasing workload (estimate −5.5, 95% CI −10.5 to −0.4, p = 0.035). Interpretation: A substantial number of cancer patients treated with proton therapy experience financial toxicity in Switzerland. Long travel distances to the proton therapy centre and low income negatively affect the financial well-being of these patients during proton therapy. Full article
(This article belongs to the Special Issue Disparities in Cancer Prevention, Screening, Diagnosis and Management)
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