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Impacts of Bicycle Infrastructure in Mid-Sized Cities (IBIMS): protocol for a natural experiment study in three Canadian cities
  1. Meghan Winters1,2,
  2. Michael Branion-Calles1,2,
  3. Suzanne Therrien1,
  4. Daniel Fuller3,4,
  5. Lise Gauvin5,6,
  6. David G T Whitehurst1,7,
  7. Trisalyn Nelson8
  1. 1 Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
  2. 2 Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada
  3. 3 School of Human Kinetics and Recreation, Memorial University, St John’s, Newfoundland and Labrador, Canada
  4. 4 Department of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John’s, Newfoundland and Labrador, Canada
  5. 5 Centre de recherche du Centre Hospitalier de l’Université de Montréal (CRHCUM), Montréal, Québec, Canada
  6. 6 Département de médecine sociale et préventive, École de santé publique de l’Université de Montréal (ESPUM), Montréal, Québec, Canada
  7. 7 Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
  8. 8 School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, Arizona, USA
  1. Correspondence to Dr Meghan Winters; mwinters{at}


Introduction 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.

Methods and analysis The study is in three Canadian cities (intervention: Victoria; comparison: Kelowna, Halifax). We will administer population-based surveys in 2016, 2018 and 2021 (1000 people/city). The primary outcome is the proportion of people reporting bicycling. Secondary outcomes are perceived safety and bicycle safety incidents. Spatial analyses will compare the distribution of bicycle infrastructure and bicycle safety incidents across neighbourhoods and across time. We will also calculate the economic benefits of bicycling using WHO’s Health Economic Assessment Tool.

Ethics and dissemination This study received approval from the Simon Fraser University Office of Research Ethics (study no. 2016s0401). Findings will be disseminated via a website, presentations to stakeholders, at academic conferences and through peer-reviewed journal articles.

  • natural experiment
  • population health
  • safety
  • active transportation
  • bicycling

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  • Contributors MW, MB-C, DF, LG, DGTW and TN all contributed to the development of this protocol. ST manages this study and MB-C has contributed to data analysis. All authors read and contributed to the final manuscript.

  • Funding This study was funded by the Canadian Institutes of Health Research (Awards #365011 and #377333).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study received ethical approval from the Simon Fraser University Office of Research Ethics (study no. 2016s0401, minimal risk).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Original participant data are protected as per ethics board guidance. Aggregate results will be published and shared with the academic audiences, stakeholders and the public.

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