Abstracts

Introduction

Bicycling has the potential to promote numerous health benefits, including better cardiorespiratory fitness and a decreased risk of developing cardiovascular disease ¹1 Bull FC, Gauvin L, Bauman A, Shilton T, Kohl 3rd HW, Salmon A. The Toronto Charter for Physical Activity: a global call for action. J Phys Act Health 2010; 7:421-2. ^{, 2}2 Oja P, Titze S, Bauman A, de Geus B, Krenn P, Reger-Nash B, et al. Health benefits of cycling: a systematic review. Scand J Med Sci Sports 2011; 21:496-509. and being overweight or obese ³3 Wen LM, Rissel C. Inverse associations between cycling to work, public transport, and overweight and obesity: findings from a population based study in Australia. Prev Med 2008; 46:29-32.. Moreover, this mode of transportation may help to reduce physical inactivity ⁴4 Engbers LH, Hendriksen IJ. Characteristics of a population of commuter cyclists in the Netherlands: perceived barriers and facilitators in the personal, social and physical environment. Int J Behav Nutr Phys Act 2010; 7:89., which is a leading cause of death worldwide ⁵5 Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 2012; 380:219-29. and to reduce congestion, carbon emissions and the consumption of fossil fuels ⁶6 Woodcock J, Banister D, Edwards P, Prentice AM, Roberts I. Energy and transport. Lancet 2007; 370:1078-88.. Despite these benefits, the use of the bicycle for transportation and leisure is low, both in high-income countries ⁷7 Winters M, Friesen MC, Koehoorn M, Teschke K. Utilitarian bicycling: a multilevel analysis of climate and personal influences. Am J Prev Med 2007; 32:52-8. ^{, 8}8 Titze S, Giles-Corti B, Knuiman MW, Pikora TJ, Timperio A, Bull FC, et al. Associations between intrapersonal and neighborhood environmental characteristics and cycling for transport and recreation in adults: baseline results from the RESIDE study. J Phys Act Health 2010; 7:423-31. and in low- and middle-income countries ⁹9 Cervero R, Sarmiento O, Jacoby E, Gomez LF, Neiman A. Influences of built environments on walking and cycling: lessons from Bogotá. International Journal of Sustainable Transportation 2009; 3:203-26. ^{, 10}10 Parra DC, Hoehner CM, Hallal PC, Ribeiro IC, Reis R, Brownson RC, et al. Perceived environmental correlates of physical activity for leisure and transportation in Curitiba, Brazil. Prev Med 2011; 52:234-8.. In Brazil, an estimated 8 to 16% of adults commute by bicycle ¹¹11 Reis RS, Hino AAF, Parra DC, Hallal PRC, Brownson RC. Bicycling and walking for transportation in three Brazilian cities. Am J Prev Med 2013; 44:e9-17., a prevalence similar to that of Canada ⁷7 Winters M, Friesen MC, Koehoorn M, Teschke K. Utilitarian bicycling: a multilevel analysis of climate and personal influences. Am J Prev Med 2007; 32:52-8. ^{, 12}12 Butler GP, Orpana HM, Wiens AJ. By your own two feet: factors associated with active transportation in Canada. Can J Public Health 2007; 98:259-64. ^{, 13}13 . Winters M, Brauer M, Setton EM, Teschke K. Built environment influences on healthy transportation choices: bicycling versus driving. J Urban Health 2010; 87:969-93. and Australia ⁸8 Titze S, Giles-Corti B, Knuiman MW, Pikora TJ, Timperio A, Bull FC, et al. Associations between intrapersonal and neighborhood environmental characteristics and cycling for transport and recreation in adults: baseline results from the RESIDE study. J Phys Act Health 2010; 7:423-31. but lower than in European countries ¹⁴14 de Geus B, De Bourdeaudhuij I, Jannes C, Meeusen R. Psychosocial and environmental factors associated with cycling for transport among a working population. Health Educ Res 2008; 23:697-708. ^{, 15}15 Huy C, Becker S, Gomolinsky U, Klein T, Thiel A. Health, medical risk factors, and bicycle use in everyday life in the over-50 population. J Aging Phys Act 2008; 16:454-64. ^{, 16}16 Hendriksen IJ, Simons M, Garre FG, Hildebrandt VH. The association between commuter cycling and sickness absence. Prev Med 2010; 51:132-5.. The use of the bicycle in leisure time is one of the five most common forms of physical activity among Brazilian adults ¹⁷17 Malta DCM, Moura EC, Castro AM, Cruz DKA, Morais Neto OL, Monteiro CA. Padrão de atividade física em adultos brasileiros: resultados de um inquérito por entrevistas telefônicas, 2006. Epidemiol Serv Saúde 2009; 18:7-16.. Data from other countries show a wide variation. For example, between 9.7 and 42% of adults report using a bicycle during leisure time in Australia ⁸8 Titze S, Giles-Corti B, Knuiman MW, Pikora TJ, Timperio A, Bull FC, et al. Associations between intrapersonal and neighborhood environmental characteristics and cycling for transport and recreation in adults: baseline results from the RESIDE study. J Phys Act Health 2010; 7:423-31. ^{, 18}18 Rissel C, Merom D, Bauman A, Garrard J, Wen LM, New C. Current cycling, bicycle path use, and willingness to cycle more-findings from a community survey of cycling in southwest Sydney, Australia. J Phys Act Health 2010; 7:267-72. ^{, 19}19 Heesch KC, Sahlqvist S, Garrard J. Gender differences in recreational and transport cycling: a cross-sectional mixed-methods comparison of cycling patterns, motivators, and constraints. Int J Behav Nutr Phys Act 2012; 9:106., while one in of four adults in the United States and Europe do so ⁴4 Engbers LH, Hendriksen IJ. Characteristics of a population of commuter cyclists in the Netherlands: perceived barriers and facilitators in the personal, social and physical environment. Int J Behav Nutr Phys Act 2010; 7:89..

In fact, personal, behavioral and environmental factors are associated with bicycling for leisure time and transportation ⁸8 Titze S, Giles-Corti B, Knuiman MW, Pikora TJ, Timperio A, Bull FC, et al. Associations between intrapersonal and neighborhood environmental characteristics and cycling for transport and recreation in adults: baseline results from the RESIDE study. J Phys Act Health 2010; 7:423-31. ^{, 20}20 Pikora T, Giles-Corti B, Bull F, Jamrozik K, Donovan R. Developing a framework for assessment of the environmental determinants of walking and cycling. Soc Sci Med 2003; 56:1693-703.. In high-income countries, bicycling is more frequent among men ⁸8 Titze S, Giles-Corti B, Knuiman MW, Pikora TJ, Timperio A, Bull FC, et al. Associations between intrapersonal and neighborhood environmental characteristics and cycling for transport and recreation in adults: baseline results from the RESIDE study. J Phys Act Health 2010; 7:423-31. ^{, 9}9 Cervero R, Sarmiento O, Jacoby E, Gomez LF, Neiman A. Influences of built environments on walking and cycling: lessons from Bogotá. International Journal of Sustainable Transportation 2009; 3:203-26. ^{, 13}13 . Winters M, Brauer M, Setton EM, Teschke K. Built environment influences on healthy transportation choices: bicycling versus driving. J Urban Health 2010; 87:969-93. ^{, 18}18 Rissel C, Merom D, Bauman A, Garrard J, Wen LM, New C. Current cycling, bicycle path use, and willingness to cycle more-findings from a community survey of cycling in southwest Sydney, Australia. J Phys Act Health 2010; 7:267-72., younger adults ¹²12 Butler GP, Orpana HM, Wiens AJ. By your own two feet: factors associated with active transportation in Canada. Can J Public Health 2007; 98:259-64., low socioeconomic status groups ¹³13 . Winters M, Brauer M, Setton EM, Teschke K. Built environment influences on healthy transportation choices: bicycling versus driving. J Urban Health 2010; 87:969-93. ^{, 21}21 Plaut PO. Non-motorized commuting in the US. Transportation Research Part D: Transport and Environment 2005; 10:347-56. and those reporting good health ¹⁵15 Huy C, Becker S, Gomolinsky U, Klein T, Thiel A. Health, medical risk factors, and bicycle use in everyday life in the over-50 population. J Aging Phys Act 2008; 16:454-64.. However, data from low and middle-income countries is scarce. Economic and social aspects, such as a larger low income population ⁹9 Cervero R, Sarmiento O, Jacoby E, Gomez LF, Neiman A. Influences of built environments on walking and cycling: lessons from Bogotá. International Journal of Sustainable Transportation 2009; 3:203-26. ^{, 22}22 Bacchieri G, Gigante DP, Assunção MC. Determinantes e padrões de utilização da bicicleta e acidentes de trânsito sofridos por ciclistas trabalhadores da cidade de Pelotas, Rio Grande do Sul, Brasil. Cad Saúde Pública 2005; 21:1499-508., social norms that do not value the bicycle as a means of transportation, the aggressive behavior of drivers ¹⁹19 Heesch KC, Sahlqvist S, Garrard J. Gender differences in recreational and transport cycling: a cross-sectional mixed-methods comparison of cycling patterns, motivators, and constraints. Int J Behav Nutr Phys Act 2012; 9:106. and a lack of facilities for bicycling ²³23 Tin Tin S, Woodward A, Thornley S, Langley J, Rodgers A, Ameratunga S. Cyclists’ attitudes toward policies encouraging bicycle travel: findings from the Taupo Bicycle Study in New Zealand. Health Promot Int 2009; 25:54-62. may present challenges to the promotion of bicycling in these countries. To identify the correlates of bicycling will help to improve interventions, programs and policies aiming at promoting the adoption of bicycling ²⁴24 Sallis JF, Floyd MF, Rodriguez DA, Saelens BE. Role of built environments in physical activity, obesity, and cardiovascular disease. Circulation 2012; 125:729-37.. Thus, this study aims to investigate the association of personal and behavioral traits with bicycling for transportation and leisure in adults from Curitiba, Paraná State, Brazil.

Methods

The results of this study are part of the ESPAÇOS Project ²⁵25 Hino AAF, Rech CR, Gonçalves PB, Hallal PC, Reis RS. Projeto ESPAÇOS de Curitiba, Brasil: aplicabilidade de métodos mistos de pesquisa e informações georreferenciadas em estudos sobre atividade física e ambiente construído. Rev Panam Salud Pública 2012; 32:226-32. which was conducted in Curitiba, in 2010. The ESPAÇOS Project was a cross-sectional survey conducted in census tracts selected according to walkability and income characteristics. The study included 16 census tracts with high walkability (eight low-income and eight high-income census tracts) and 16 with low walkability (eight low-income and eight high-income census tracts). After power estimations a minimum sample of 22 individuals per census tract was adopted (n = 704 persons; 50% women). For the selection of households, all were visited and a total of 10,063 households were identified (average-314 ± 111 households per census tract). Within each census tract the households were systematically selected from a list of all eligible households. Among the selected participants (n = 704) a total of 699 participants (53.1% women), completed all interviews. The overall success rate was 66.4% and was higher in high-income census tracts (71.2% and 70.9%) compared to low-income ones (62.6% and 62.3%), while the overall refusal rate was 29.5%, which was similar between the strata (χ2 = 5.09; p = 0.165). Further details about census tract selection, sample design and data collection can be obtained else- where ²⁵25 Hino AAF, Rech CR, Gonçalves PB, Hallal PC, Reis RS. Projeto ESPAÇOS de Curitiba, Brasil: aplicabilidade de métodos mistos de pesquisa e informações georreferenciadas em estudos sobre atividade física e ambiente construído. Rev Panam Salud Pública 2012; 32:226-32.. Participants were adults aged between 18 and 65 years who had lived in the neighborhood for at least one year. Individuals with physical disabilities and domestic staff were ineligible for the study ²⁵25 Hino AAF, Rech CR, Gonçalves PB, Hallal PC, Reis RS. Projeto ESPAÇOS de Curitiba, Brasil: aplicabilidade de métodos mistos de pesquisa e informações georreferenciadas em estudos sobre atividade física e ambiente construído. Rev Panam Salud Pública 2012; 32:226-32.. The study was approved by the Ethics Committee of the Pontifícia Universidade Católica do Paraná, Brazil (protocol n. 3034/2009).

Bicycling for transportation and leisure was assessed by self-report according to the frequency (days per week) and time (minutes per day) using the International Physical Activity Questionnaire (IPAQ) ²⁶26 Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003; 35:1381-95.. The questions were pilot-tested, and the test-retest agreement (95.5 and 97%) and intraclass correlation coefficient (0.82 and 0.74) were deemed suitable for the study.

The data collected included gender, age, marital status (single, separated, widowed, married, or living with a partner), children (yes/no), education (elementary school, high school or university degree), and work status (yes/no). Socioeconomic status was determined according to the assets within the household and family education ²⁷27 Associação Brasileira de Empresas de Pesquisa. Critério de classificação econômica Brasil. São Paulo: Associação Brasileira de Empresas de Pesquisa; 2010. and was categorized into three levels (high, medium or low). The individuals were also asked about bicycle and car ownership (yes/no). Bicycling and walking for transportation and leisure time physical activity were assessed through the IPAQ-long version, which was validated for the Brazilian population ²⁸28 Matsudo S, Araújo T, Marsudo V, Andrade D, Andrade E. International Physical Activity Questionnaire (IPAQ): study of validity and reability in Brazil. Rev Bras Ativ Fís Saúde 2001; 6:5-18.. The participants reported the frequency (day/week) and duration (minutes/day) of walking and moderate-intensity and vigorous-intensity physical activity. The physical activity level was obtained by summing the time for walking and moderate and vigorous physical activity (which is multiplied by two) ²⁹29 U.S. Department of Health and Human Services. Physical activity guidelines for Americans. Washington DC: U.S. Department of Health and Human Services; 2008.. The individuals were classified as inactive (< 10 minutes/week), insufficiently active (10 to 149 minutes/week) or active (≥ 150 minutes/week) ²⁹29 U.S. Department of Health and Human Services. Physical activity guidelines for Americans. Washington DC: U.S. Department of Health and Human Services; 2008.. Finally, perceptions about quality of life and general health conditions were assessed using the World Health Organization Quality of Life Instrument (WHOQOL-8) ³⁰30 Power M. Development of a common instrument for quality of life. In: Nasikov A, Gudex C, editors. EUROHIS: developing common instruments for health surveys. Amsterdam: IOS Press; 2003. p. 145-59..

Double data entry was used with Epidata 3.1 (Epidata Assoc., Odense, Denmark). Absolute and relative frequencies and the chi-square test were used to describe the sample. The associations between bicycling for transportation and in leisure time with the independent variables were analyzed using a Poisson regression. Initially, the association between each independent variable with bicycling outcomes was tested (bivariate analyses), and all variables were used in the multivariable models. All analyses were conducted using Stata 11.1 (Stata Corp., College Station, USA), and the final models considered a significance level of 5%.

Results

The study included 704 adults (53.1% female) between 18 and 65 years old (66.4% of success rate) ²⁵25 Hino AAF, Rech CR, Gonçalves PB, Hallal PC, Reis RS. Projeto ESPAÇOS de Curitiba, Brasil: aplicabilidade de métodos mistos de pesquisa e informações georreferenciadas em estudos sobre atividade física e ambiente construído. Rev Panam Salud Pública 2012; 32:226-32.. After checking for missing data, 27 adults (3.8%) were excluded, and the final analytical sample was made up of 677 subjects. Bicycling for transportation and in leisure time was reported by 11.2% (95%CI: 9.0-14.0) and 16.7% (95%CI: 14.0-20.0) of the sample, respectively. Overall, men reported more frequent bicycling for transportation (19.1% men, 4.2% women; p < 0.001) and in leisure time (25.3% men, 9% women; p < 0.001) than did women. Additionally, men also reported higher bicycle ownership (49.1% men, 37.3% women; p = 0.002), socioeconomic status (13.4% men, 9.8% women; p = 0.011), car ownership (82.2% men, 70.9% women; p = 0.001), positive perception of quality of life (78.4% men, 67.2% women; p = 0.001) and positive perception of health (76.9% men, 67.2% women; p = 0.005) than did women. Other sociodemographic characteristics of the sample are presented in Table 1 .

Overall, bicycling in leisure time was more frequent among men, young adults, bicycle owners, physically active individuals and those with a positive perception of their health ( Table 2 ). In the multivariable analysis, bicycling in leisure time was higher among men (PR = 2.08; 95%CI: 1.66-2.60; p < 0.001), young adults (< 30 years old: PR = 2.03; 95%CI: 1.25-3.30; p = 0.006; 30.0 to 39.9 years: PR = 1.64; 95%CI: 1.02-2.62; p = 0.03), bicycle owners (PR = 8.76; 95%CI: 4.86-15,78; p < 0.001) and physically active individuals (PR = 2.41; 95%CI: 1.50-3.87; p = 0.001).

In the bivariate analysis ( Table 3 ), most of the variables were associated with bicycling for transportation. After adjusting for all confounding variables, men (PR = 3.63; 95%CI: 2.45-5.35; p < 0.001), bicycle owners (PR = 10.2; 95%CI: 5.35-19.58; p < 0.001), those aged between 30 and 39.9 (PR = 1.68; 95%CI: 1.04-2.73; p = 0.034), those of low socioeconomic status (PR = 5.00; 95%CI: 1.65-15.17; p = 0.006), and those with a negative perception of their quality of life (PR = 1.59; 95%CI: 1.04-2.43; p = 0.033) reported using a bicycle for transportation more frequently.

Discussion

The results of this study demonstrate the personal and behavioral aspects that are associated with bicycling in Curitiba. The analyses were conducted for separate bicycling outcomes (e.g., leisure and transportation), which, to the best of the authors’ knowledge, has not previously been explored in low or middle-income countries. Bicycling was more frequent for leisure than for transportation (16.7% for leisure, 11.2% for transportation; p < 0.001). Only one in five individuals (17.7%) demonstrated behavior related to the use of a bicycle as a form of physical activity in leisure time. This result is similar to that reported in Australia (19%) but lower than that found in the Netherlands (27.2%) ⁴4 Engbers LH, Hendriksen IJ. Characteristics of a population of commuter cyclists in the Netherlands: perceived barriers and facilitators in the personal, social and physical environment. Int J Behav Nutr Phys Act 2010; 7:89. ^{, 18}18 Rissel C, Merom D, Bauman A, Garrard J, Wen LM, New C. Current cycling, bicycle path use, and willingness to cycle more-findings from a community survey of cycling in southwest Sydney, Australia. J Phys Act Health 2010; 7:267-72.. The prevalence of using a bicycle for transportation (11.2%) was similar to that found in other studies in Brazil ¹¹11 Reis RS, Hino AAF, Parra DC, Hallal PRC, Brownson RC. Bicycling and walking for transportation in three Brazilian cities. Am J Prev Med 2013; 44:e9-17. ^{, 31}31 Bacchieri G, Barros AJD, Santos JV, Gigante DP. Cycling to work in Brazil: users profile, risk behaviors, and traffic accident occurrence. Accid Anal Prev 2009; 42:1025-30.; however, the prevalence was lower than in European cities (prevalence 39.7% to 67.5%) ⁴4 Engbers LH, Hendriksen IJ. Characteristics of a population of commuter cyclists in the Netherlands: perceived barriers and facilitators in the personal, social and physical environment. Int J Behav Nutr Phys Act 2010; 7:89. ^{, 16}16 Hendriksen IJ, Simons M, Garre FG, Hildebrandt VH. The association between commuter cycling and sickness absence. Prev Med 2010; 51:132-5.. This difference may be attributed to environmental and social characteristics that can encourage or inhibit bicycling. For example, countries like the Netherlands and Denmark have a wide road network dedicated to bicycling that is integrated with the public transportation system ³²32 Pucher JB. Making cycling irresistible: lessons from the Netherlands, Denmark, and Germany. Transport Reviews 2008; 28:495-528.. Moreover, the availability of squares, parks and streets with bicycle path facilitates encourage the use of bicycling for leisure time ¹⁸18 Rissel C, Merom D, Bauman A, Garrard J, Wen LM, New C. Current cycling, bicycle path use, and willingness to cycle more-findings from a community survey of cycling in southwest Sydney, Australia. J Phys Act Health 2010; 7:267-72. ^{, 32}32 Pucher JB. Making cycling irresistible: lessons from the Netherlands, Denmark, and Germany. Transport Reviews 2008; 28:495-528.. On the other hand, in low- and middle-income countries, such facilities are not a priority ¹¹11 Reis RS, Hino AAF, Parra DC, Hallal PRC, Brownson RC. Bicycling and walking for transportation in three Brazilian cities. Am J Prev Med 2013; 44:e9-17.. Furthermore, social aspects such as a lack of public security are barriers for cyclists. For instance, one study found that a community’s perception of dangerous surroundings was correlated with greater adult physical inactivity ³³33 Rech CR, Reis RS, Hino AA, Rodriguez-Añez CR, Fermino RC, Gonçalves PB, et al. Neighborhood safety and physical inactivity in adults from Curitiba, Brazil. Int J Behav Nutr Phys Act 2012; 9:72..

These aspects can significantly contribute to a lower use of bicycling during leisure time. In this study, men cycled for leisure time more often than did women. Evidence suggests that women perceived more barriers to physical activities ¹⁹19 Heesch KC, Sahlqvist S, Garrard J. Gender differences in recreational and transport cycling: a cross-sectional mixed-methods comparison of cycling patterns, motivators, and constraints. Int J Behav Nutr Phys Act 2012; 9:106. and activities of a moderate and vigorous intensity. Moreover, women report less confidence in navigating and maintaining bicycles than do men ¹⁹19 Heesch KC, Sahlqvist S, Garrard J. Gender differences in recreational and transport cycling: a cross-sectional mixed-methods comparison of cycling patterns, motivators, and constraints. Int J Behav Nutr Phys Act 2012; 9:106.. These aspects may partially explain why the young (aged between 18 and 39.9) reported more bicycling compared to other age groups, which is corroborated by the literature ¹³13 . Winters M, Brauer M, Setton EM, Teschke K. Built environment influences on healthy transportation choices: bicycling versus driving. J Urban Health 2010; 87:969-93. ^{, 18}18 Rissel C, Merom D, Bauman A, Garrard J, Wen LM, New C. Current cycling, bicycle path use, and willingness to cycle more-findings from a community survey of cycling in southwest Sydney, Australia. J Phys Act Health 2010; 7:267-72.. These findings may be related to lower physical fitness in the elderly, which may be explained by a decreasing confidence in bicycling with advancing age ³⁴34 Cassou AC, Fermino R, Rodriguez-Añez CR, Santos MS, Domingues MR, Reis RS. Barriers to physical activity among Brazilian elderly women from different socioeconomic status: a focus-group study. J Phys Act Health 2011; 8:126-32.. The results also show that physically active individuals had a higher rate of bicycling during leisure time ¹²12 Butler GP, Orpana HM, Wiens AJ. By your own two feet: factors associated with active transportation in Canada. Can J Public Health 2007; 98:259-64. ^{, 35}35 Moudon AV, Lee C, Cheadle AD, Collier CW, Johnson D, Schmid TL, et al. Cycling and the built environment, a US perspective. Transportation Research Part D: Transport and Environment 2005; 10:245-61.. Similar results were observed in this study in bicycling for transportation, which was more prevalent among men, and these results are supported by similar studies in Brazil ¹¹11 Reis RS, Hino AAF, Parra DC, Hallal PRC, Brownson RC. Bicycling and walking for transportation in three Brazilian cities. Am J Prev Med 2013; 44:e9-17. ^{, 31}31 Bacchieri G, Barros AJD, Santos JV, Gigante DP. Cycling to work in Brazil: users profile, risk behaviors, and traffic accident occurrence. Accid Anal Prev 2009; 42:1025-30. and other countries ⁸8 Titze S, Giles-Corti B, Knuiman MW, Pikora TJ, Timperio A, Bull FC, et al. Associations between intrapersonal and neighborhood environmental characteristics and cycling for transport and recreation in adults: baseline results from the RESIDE study. J Phys Act Health 2010; 7:423-31. ^{, 9}9 Cervero R, Sarmiento O, Jacoby E, Gomez LF, Neiman A. Influences of built environments on walking and cycling: lessons from Bogotá. International Journal of Sustainable Transportation 2009; 3:203-26. ^{, 19}19 Heesch KC, Sahlqvist S, Garrard J. Gender differences in recreational and transport cycling: a cross-sectional mixed-methods comparison of cycling patterns, motivators, and constraints. Int J Behav Nutr Phys Act 2012; 9:106.. In part, these results may be explained by women’s perceived vulnerability to criminals and violence ¹⁹19 Heesch KC, Sahlqvist S, Garrard J. Gender differences in recreational and transport cycling: a cross-sectional mixed-methods comparison of cycling patterns, motivators, and constraints. Int J Behav Nutr Phys Act 2012; 9:106..

Additionally, middle-aged adults (aged 30 to 39.9 years) reported a higher frequency of bicycling for transportation, which is corroborated by other studies ⁷7 Winters M, Friesen MC, Koehoorn M, Teschke K. Utilitarian bicycling: a multilevel analysis of climate and personal influences. Am J Prev Med 2007; 32:52-8. ^{, 9}9 Cervero R, Sarmiento O, Jacoby E, Gomez LF, Neiman A. Influences of built environments on walking and cycling: lessons from Bogotá. International Journal of Sustainable Transportation 2009; 3:203-26. ^{, 12}12 Butler GP, Orpana HM, Wiens AJ. By your own two feet: factors associated with active transportation in Canada. Can J Public Health 2007; 98:259-64. ^{, 13}13 . Winters M, Brauer M, Setton EM, Teschke K. Built environment influences on healthy transportation choices: bicycling versus driving. J Urban Health 2010; 87:969-93.. One hypothesis is that middle-aged adults are more economically active, and bicycles are an efficient and inexpensive way of arriving at work ¹⁴14 de Geus B, De Bourdeaudhuij I, Jannes C, Meeusen R. Psychosocial and environmental factors associated with cycling for transport among a working population. Health Educ Res 2008; 23:697-708. ^{, 19}19 Heesch KC, Sahlqvist S, Garrard J. Gender differences in recreational and transport cycling: a cross-sectional mixed-methods comparison of cycling patterns, motivators, and constraints. Int J Behav Nutr Phys Act 2012; 9:106.; however, the lack of information about travel destination prevents the testing of this hypothesis. The proportion of cyclists was higher among those with lower socioeconomic status, which is consistent with the literature ⁷7 Winters M, Friesen MC, Koehoorn M, Teschke K. Utilitarian bicycling: a multilevel analysis of climate and personal influences. Am J Prev Med 2007; 32:52-8. ^{, 12}12 Butler GP, Orpana HM, Wiens AJ. By your own two feet: factors associated with active transportation in Canada. Can J Public Health 2007; 98:259-64. ^{, 13}13 . Winters M, Brauer M, Setton EM, Teschke K. Built environment influences on healthy transportation choices: bicycling versus driving. J Urban Health 2010; 87:969-93. ^{, 21}21 Plaut PO. Non-motorized commuting in the US. Transportation Research Part D: Transport and Environment 2005; 10:347-56. and supports the hypotheses presented above. The inverse association between bicycling and the perception of quality of life was unexpected. This result may be due to the positive relationship between income and cycling, which could indicate that low socioeconomic status individuals may be dissatisfied with their general living conditions, regardless of the use of the bicycle. Comparisons with the literature were limited because there is a paucity of work on this subject in low- and middle-income countries. Finally, the ownership of a bicycle was associated with bicycling for both transportation and leisure time, which is similar to results observed in other studies ⁹9 Cervero R, Sarmiento O, Jacoby E, Gomez LF, Neiman A. Influences of built environments on walking and cycling: lessons from Bogotá. International Journal of Sustainable Transportation 2009; 3:203-26. ^{, 18}18 Rissel C, Merom D, Bauman A, Garrard J, Wen LM, New C. Current cycling, bicycle path use, and willingness to cycle more-findings from a community survey of cycling in southwest Sydney, Australia. J Phys Act Health 2010; 7:267-72. ^{, 35}35 Moudon AV, Lee C, Cheadle AD, Collier CW, Johnson D, Schmid TL, et al. Cycling and the built environment, a US perspective. Transportation Research Part D: Transport and Environment 2005; 10:245-61.. These findings, which are consistent with the literature, reinforce the importance of access to bicycles as a key step in encouraging their use. Furthermore, the association between bicycling for leisure and meeting physical activity guidelines suggests that bike use could represent an important contribution for adequate levels of physical activity. This is also an important contribution of this paper since most studies on bicycling have mainly analyzed bicycling for transportation.

The study has some limitations. The cross-sectional design does not allow for cause and effect to be established. The selection of census tracts in accordance with the levels of walkability and socioeconomic status of the neighborhood may not represent all sectors of Curitiba city. However, the selection of groups with high and low potential environmental and distinct socioeconomic status can minimize this bias. Furthermore, the prevalence of bicycling in the current study was similar to other surveys conducted in Curitiba ¹⁰10 Parra DC, Hoehner CM, Hallal PC, Ribeiro IC, Reis R, Brownson RC, et al. Perceived environmental correlates of physical activity for leisure and transportation in Curitiba, Brazil. Prev Med 2011; 52:234-8. ^{, 11}11 Reis RS, Hino AAF, Parra DC, Hallal PRC, Brownson RC. Bicycling and walking for transportation in three Brazilian cities. Am J Prev Med 2013; 44:e9-17.. Because only physical activity was included in this study other health behaviors should be included in future studies. The success rate of 66.4% was somewhat low, however it was even higher than the rates observed in similar studies ³⁶36 Heerwegh D, Abts K, Loosveldt G. Minimizing survey refusal and noncontact rates: do our efforts pay off. Surv Res Methods 2007; 1:3-10. ^{, 37}37 Van Dyck D, Cardon G, Deforche B, Sallis JF, Owen N, De Bourdeaudhuij I. Neighborhood SES and walkability are related to physical activity behavior in Belgian adults. Prev Med 2010; 50 Suppl 1:S74-9.. Additionally, the city of Curitiba has structures for bicycling, such as bike paths connecting public parks, which may contribute to a higher use ³⁸38 Reis RS, Hallal PC, Parra DC, Ribeiro IC, Brownson RC, Pratt M, et al. Promoting physical activity through community-wide policies and planning: findings from Curitiba, Brazil. J Phys Act Health 2010; 7 Suppl 2:S137-45.. Thus, comparison with other cities in Brazil should be made with caution. Environmental factors were not available to be included in the analysis, although they represent important factors for bicycling. Because the survey used self-reported measures of bicycling, the prevalence may have been overestimated. Finally, no information was collected about the commuting distance (e.g. distance and destination), which may be an important confounding factor in the analysis; however, this factor was considered in a different study that showed similar results ²²22 Bacchieri G, Gigante DP, Assunção MC. Determinantes e padrões de utilização da bicicleta e acidentes de trânsito sofridos por ciclistas trabalhadores da cidade de Pelotas, Rio Grande do Sul, Brasil. Cad Saúde Pública 2005; 21:1499-508.. Therefore, it is concluded that Curitiba has less bicycling than European cities but rates similar to those of locations in North and Latin America.

The prevalence and factors associated with bicycling were specific to the type of use. It is recommended that programs to encourage bicycling focus on strategies to guarantee access to this modality, such as decreasing the price of bicycles and equipment and focusing more on women and older adults. Recently several tools have been identified to help implement changes to the Brazilian context for making it more conducive for physical activity ³⁹39 Pucci GC, Rech CR, Fermino RC, Reis RS. Associação entre atividade física e qualidade de vida em adultos. Rev Saúde Pública 2012; 46:166-79.. The findings from this study highlight the need for such changes in order to promote bicycling in the community. At the individual level, it will be useful to identify the motivational factor and barriers to bicycling in the subgroups identified in this study to tailor interventions more effectively.

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