Objective: Promoting cycling has moved up the policy agenda in recent years, but debate still exists surrounding the role played by socioeconomic barriers to participation in low cycling countries. This ecological study aimed to examine whether there are systematic socioeconomic disparities in access to cycling infrastructure and investment in Melbourne, Australia. Methods:We used Geographic Information System (GIS) techniques to measure the density of on-road, off-road and informal cycling routes in 58 neighbourhoods of inner Melbourne. We examined whether small-area socioeconomic indicators were associated with the density of these three types of cycling infrastructure or with local government spending on cycling. We additionally examined how small-area socio-economic position and infrastructure density were associated with the prevalence of cycling to work in the 2011 census. Results:The density of on-and off-road cycling infrastructure was positively associated with cycle modal share (both p<0.0001), and there was no evidence that the strength of this association differed between the two infrastructure types. The density of informal routes was not associated with cycling to work. There was no evidence that small-area socioeconomic position was systematically associated with the presence of on-road or quiet roads cycling infrastructure or with levels of investment. Levels of off-road infrastructure were somewhat higher in richer areas (r=0.32, p=0.02), although much of this was located in parkland and may have a predominant recreational function. Conclusion:In Melbourne, cycling infrastructure is positively correlated with cycle prevalence and is generally distributed equitably with respect to area-level socioeconomic position. In part this reflects the high levels of cycling infrastructure and spending in some relatively disadvantaged areas. Further studies that seek to understand the drivers behind successful policies in these areas may provide lessons for other areas, and aid our understanding of the complex relationships between cycling infrastructure, cycling behavior and socioeconomic position.

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Introduction Professional identity development is a central aim of medical education, which has been disrupted during COVID-19. Yet, no research has qualitatively explored COVID-19’s impact across institutions or countries on medical students’ identities. Kegan proposes a cognitive model of identity development, where ‘disorientating dilemmas’ prompt student development. Given the potential of COVID-related disruption to generate disorientating dilemmas, the authors investigated the ways in which COVID-19 influenced students’ identity development. Methods The authors conducted an international qualitative study with second year medical students from Imperial College London, and third year students from Melbourne Medical School. Six focus groups occurred 2020–2021, with three to six students per group. Authors analysed data using reflexive thematic analysis, applying Kegan’s model as a sensitising theoretical lens. Results COVID-19 has resulted in a loss of clinical exposure, loss of professional relationships, and a shift in public perception of physicians. Loss of exposure to clinical practice removed the external validation from patients and seniors many students depended on for identity development. Students’ experiences encouraged them to assume the responsibilities of the profession and the communities they served, in the face of conflicting demands and risk. Acknowledging and actioning this responsibility facilitated identity development as a socially responsible advocate. Conclusions Educators should consider adapting medical education to support students through Kegan’s stages of development. Measures to foster relationships between students, patients, and staff are likely necessary. Formal curricula provisions, such as spaces for reflection and opportunities for social responsibility, may aid students in resolving the conflict many have recently experienced.

This study aims to explore changes in uptake and cessation of walking, cycling and public transport use across the lifespan in a representative sample of UK adults aged 16 and older. A longitudinal analysis of 11,559 individuals in waves two (2010–2012) and six (2014–2016) of the General Population Sample (GPS) of the UK Household Longitudinal Survey (UKHLS) was performed. The outcome variables were self-reported and categorised as changes to and from 1) walking or cycling and 2) public transport. In adjusted models compared to younger adults (aged 16–34), middle-aged adults (aged 45–55: OR 0.66, p = 0.050) and older adults (aged >55: OR 0.53, p = 0.017) were significantly less likely to initiate walking/cycling during the study period. Middle and older aged adults were also significantly less likely to cease walking/cycling (aged 45–55: OR 0.68, p = 0.019; aged >55: OR 0.46, p < 0.001) and public transport use (aged 45–55: OR 0.33, p < 0.001; aged >55: OR 0.28, p < 0.001). Dose response relationships were observed where increasing age was associated with increased stability in transport mode. Developmental processes in early adulthood may contribute to self-selection and sustainability of active commuting in later life. Active travel programs and policies that target younger adults may be an efficient means to increase and sustain participation in active commuting.