Presentation by Yan Kestens at the 'e-tools and Social Networks for Epidemiology' conference held at Paris on May 22nd 2013

1. Managing large cohorts and
collecting data on mobility and
health behaviour :
Novel solutions and challenges
Yan Kestens
Montreal University, Social and Preventive Medicine
Montreal Hospital University Research Center (CRCHUM)
SPHERE Lab .org
Paris, France
21th May 2013

2. Aim
Presentation of tools/methods that facilitate the
collection of data in large cohorts (with a focus on
spatial data)
Three tools that have been pilot tested or implemented
in existing cohort studies
– Tool 1: Study Management Application
– Tool 2: VERITAS interactive mapping questionnaire
– Tool 3: Multisensor platform for real-time tracking

3. Managing a cohort
Large cohorts  All kinds of challenges!
Recruitment
Participants
Interviewers
Questionnaires
Devices
Database
Attrition
Residential
moves
Confidentiality
Coordinators
Participation
rate
Bias
Investigators
Data collection
Tracking
Data linkage
GIS

4. Managing a cohort
Recruitment
Participants
Interviewers
Questionnaires
Database
CoordinatorsInvestigators
Data
collection
Tracking
Data linkage GIS
Sampling
Measurements Hardware
Administrative
datasources
Recruiters
Follow-up
Modelling

5. Attrition
Residential
move
Confidentiality
Participation
rate
Bias Loss-to-follow-
up
Compliance
Managing a cohort
Transversal Challenges!

6. Tool 1: Cohort Management
Application
Use of a study management application to manage
– People
– Procedures
– Questionnaires
– Devices
– Procedures

14. Study Management Application
• A comprehensive application to manage cohorts
• Facilitates the process
• Keeps track of activities
• Integrates questionnaires

15. Tool 2: Spatial data collection tool
• Environmental determinants increasingly at stake,
both as a cause of disease, social health inequalities,
and as a target for intervention
• Current shift to improve integration of daily mobility
and multiple exposures in epidemiological models

16. Collecting spatial information
• Tools to collect location information include:
– Residential history questionnaires – lifecourse
– Travel surveys – often one day of detailed mobility
– Activity space questionnaires – asking people’s
regular destinations
– Real-time tracking using GPS receivers

17. Spatial data used in health research
Place of
residence /
Residential
history

18. Spatial data used in health research
Regular activity
places

19. Spatial data used in health research
Routes / GPS
tracks

20. Spatial data used in health research
Perceived
spaces

21. Spatial data used in health research
Attribute data:
Frequency
Attachment
Perception
Travel mode
Constraints
With whom
Etc.

22. VERITAS, an online mapping
questionnaire
• Uses an interactive map to collect spatial data
• Can be administered or self-administered
• Flexible and scalable
• Allows to collect information on locations, routes,
spaces and related qualitative assessment
• Is linked to mapping and search APIs to facilitate the
process and increase validity (Openstreetmap,
Google Map, etc.)

23. VERITAS
A series of questions which can be answered on a map
through creation of:
– A point location (marker)
– A line (polyline)
– An area (polygon)
Map searching capabilities / streetview
functionalities can help identifying known
locations/destinations.

24. VERITAS
Example: Where do you shop for food most often?

25. VERITAS RECORD
• Illustration: VERITAS in the RECORD Study
• RECORD Study: Large Paris area cohort on Cardiovascular
health (n = 8,000)
• Wave 1 in 2007-2008, Wave 2 in 2012-2014
• VERITAS RECORD administered to some 4,800 participants as
of today
• 27 spatial questions including destinations for food shopping,
sport activities, leisure, friends, family, etc.
• Over 65,000 locations collected – Median of 14 locations
collected per participant
• Median completion time of 20 minutes

26. VERITAS RECORD
• Rich spatial information on regular destinations which can
serve to identify multiple environmental exposures and
inequalities
• Spatial information transformed into spatial indicators to feed
epidemiological models (Activity space size, maximum
distance, concentration etc.) (Camille Perchoux, Ph.D.
candidate)
• Interesting information to monitor spatial health inequalities,
mobility behaviour and guide intervention in the distribution
of resources/infrastructures

27. Tool 3: A multisensor platform for real-
time tracking
• Self-reported locations vs. objective measures
• Multisensor device for tracking of:
– Mobility (GPS, RFID)
– Physical activity (Accelerometer)
– Physiology (Various sensors)

28. Multisensor platform
DATA
CAPTURE
DATA
PROCESSING
DATA
USAGE

29. Multisensor platform
DATA
CAPTURE
DATA
PROCESSING
DATA
USAGE

30. Web server
Acquisition server
Outputs /
Applications
End users
GISAlgorithms
GSM towerSensors

31. Central Unit
GPS GPRS
Memory
Accelerometer
ANT Module
Acquisition server
SenseDoc multisensor
wearable device
125 g
137 g
96 * 80 mm
115 * 59 mm

32. Acquisition server
Central Unit
GPS GPRS
Memory
Accelerometer
ANT Module
Glucose
monitor
Galvanic skin
response
Accele-
rometer
HR
monitorBlood
pressure
Other
SenseDoc multisensor
wearable device

33. SenseDoc Multisensor Device
CAPTURE
Acquisition server
GPS – SIRF IV
GPS performance validation
Spatial accuracy
Time to First Fix (TTFF)
Indoor – Outdoor
Fixed - Moving

34. CAPTURE
Average of dist_moy Column Labels
Row Labels Etrex HTC MS Qstarz Grand Total
Indoor
cold 13,6 9,0 7,7 16,7 12,3
Brick building, hallway 14,1 5,7 4,1 15,4 10,4
Brick building, window 14,4 12,4 7,6 15,5 12,5
Concrete building, window 12,3 11,6 19,4 14,4
hot 12,9 11,3 10,0 15,5 12,6
Brick building, hallway 11,2 7,2 6,3 15,8 10,5
Brick building, window 7,6 5,0 6,9 12,8 8,5
Concrete building, window 19,9 21,8 16,9 17,9 18,7
warm 14,0 13,5 20,3 15,8 16,1
Brick building, hallway 10,4 15,6 22,1 11,1 14,8
Brick building, window 7,8 10,4 21,7 13,2 13,7
Concrete building, window 23,8 12,2 17,0 23,0 20,0
Outdoor
cold 7,8 16,6 11,0 17,6 13,0
Narrow streets 21,4 20,0 16,2 35,3 23,2
Open surroundings 2,8 12,0 1,4 1,1 4,3
Residential areas 2,4 4,1 0,9 2,5
Sky scrapers 4,7 17,8 22,2 33,0 19,4
hot 5,5 10,6 3,4 4,8 6,1
Narrow streets 12,9 18,6 4,9 9,5 11,5
Open surroundings 1,5 1,8 2,2 1,8 1,8
Residential areas 3,2 3,4 1,9 3,1 2,9
Sky scrapers 4,4 18,4 4,6 4,8 8,5
warm 8,6 9,1 6,5 10,0 8,5
Narrow streets 26,7 21,9 16,2 20,5 21,3
Open surroundings 3,0 5,4 3,3 4,1 3,9
Residential areas 4,1 4,6 2,8 5,0 4,1
Sky scrapers 5,0 8,9 7,4 15,2 9,1
Grand Total 10,3 11,4 9,5 13,0 11,0

35. CAPTURE
Average of ttff Column Labels
Row Labels Etrex HTC MS Qstarz Grand Total
Indoor
cold 136,3 255,0 33,2 86,3 102,3
Brick building, hallway 68,0 104,0 12,5 23,0 44,4
Brick building, window 252,0 406,0 9,5 193,0 187,9
Concrete building, window 89,0 77,5 43,0 69,8
hot 18,5 181,3 5,5 13,5 36,6
Brick building, hallway 6,5 82,0 6,0 2,5 16,0
Brick building, window 41,0 143,0 4,0 35,0 43,3
Concrete building, window 8,0 319,0 6,5 3,0 50,6
warm 101,7 293,3 46,5 204,7 149,5
Brick building, hallway 27,0 563,5 0,0 69,0 164,9
Brick building, window 107,0 26,0 84,5 191,0 113,0
Concrete building, window 171,0 20,0 55,0 354,0 168,6
Outdoor
cold 37,8 171,7 26,0 40,5 62,1
Narrow streets 44,0 247,0 36,0 40,0 91,8
Open surroundings 39,0 104,0 37,0 57,0 59,3
Residential areas 26,0 20,0 26,0 24,0
Sky scrapers 42,0 164,0 11,0 39,0 64,0
hot 16,5 36,1 21,9 10,1 21,5
Narrow streets 11,5 110,0 29,0 12,5 40,8
Open surroundings 10,5 15,0 4,5 1,0 7,8
Residential areas 8,5 10,0 7,5 3,0 7,3
Sky scrapers 35,5 9,5 46,5 38,0 31,6
warm 26,4 46,8 39,4 31,6 36,1
Narrow streets 40,0 45,0 45,0 40,0 42,5
Open surroundings 21,0 36,0 45,0 35,0 34,3
Residential areas 30,0 68,5 44,5 29,5 43,1
Sky scrapers 11,0 16,0 18,0 24,0 17,3
Grand Total 55,8 130,6 28,2 65,2 65,3

36. SenseDoc Multisensor Device
CAPTURE
Accelerometer
Marie-Lyse Bélanger, M.Sc. Student in kinesiology
Accelerometer validation using indirect calorimetry
Lab – 14 controlled exercises from sedentary to vigouros PA
Eleven adult subjects
Calculation of Vertical Magnitude Acceleration (VMAG)
Testing of various bandpass filters
Comparison with Actigraph GT3X performence
Best results obtained with Bandpass filter 0.1 Hz – 3.5 Hz
Modelling of Energy Expenditure: Adj. R-square of .79
Use of Vector Body Dynamic Acceleration (VEDBA)

37. SenseDoc Multisensor Device
CAPTURE
Battery life
Strong battery (3200 mAh)
Axelle Chevallier, M.Sc. Student in
Electrical Engineering
Mohamad Sawan, Professor,
Electrical Engineering
Battery optimisation algorithm
- Movement
- Location and movement

38. SenseDoc Multisensor Device
CAPTURE
Acquisition server
Battery life

39. SenseDoc Multisensor Device
CAPTURE
Data transmission
GPS Data sent over the air (cellphone network) every 30 minutes
Possible alerts depending on
- Location
- Activity
- Time
Connection to other sensors (2.4 GHz ANT+) Heart rate monitor,
footpod, RFID tags, etc.

40. Issues in data processing
PROCES
SING
Transforming raw GPS data into meaningful and useful
information, combining with accelerometry
- ‘Putting things into context’
- Activity locations
- Trips between locations
SPHERELAB GPS
ARCTOOLBOX
www.spherelab.org/tools

41. Usage
Using GPS/Accel to locate behaviour and assess exposure
Improve the understanding of mechanisms linking
environments to health behaviours and profiles
Use GPS to prompt recall and gain additional insight
Use GPS to support qualitative studies (go-along, geo-
ethnography, geo-tagged photos, environmental
perception, etc.)
Use GPS/Accel data to assist clinical practice (mHealth)
USAGE

42. UsageUSAGE
RECORD GPS Study, Paris
191 participants wearing GPS & Accelerometer for 7 days
Estimates of:
• Number of steps walked
• Energy expenditure
• Moderate to Vigorous physical activity
• Sedentary time
Analyses possible at the trip level and by travel mode

43. UsageUSAGE
During wear time, transportation was responsible for:
• 39% of steps walked
• 32% of total energy expenditure
• 33% of MVPA
• 15% of sedentary time

44. UsageUSAGE
Geographic variations in contribution of transport to physical activity

45. UsageUSAGE
Differences in PA compared to car driving, per 10 min of trip
(n=4,984 trips with unique mode)

46. Spherelab GPS studies
RECORD-GPS Study, Paris, Basile Chaix
BIXI bikesharing study, Montreal, Lise Gauvin
Ste-Justine CIRCUIT Pediatric Intervention, Montréal, Mélanie
Henderson
Novel Real-Time Measurement of Physical Activity Patterns in Type 2
Diabetes and Hypertension through GPS Monitoring and Accelerometry,
Kaberi Dasgupta
Healthy Aging in Urban Environments, Montreal, Paris, Luxembourg; Yan
Kestens, Basile Chaix, Philippe Gerber

47. CURHA Project
 Develop an international platform and research
agenda to collect and analyse detailed data on daily
mobility and health outcomes among older adults
living in contrasted urban settings
 Use of novel methods to capture daily mobility to
better understand interactions between
environments, mobility and health

48. Objectives
 Provide evidence about how characteristics of urban
environments relate to active mobility and social
participation
 Disentangle the complex people-environment
interactions that link urban local contexts healthy
aging

49. Methods
 Trois cohortes, 450 participants par site:
 Montréal/Sherbrooke: Cohorte NuAge
 Paris: Cohorte RECORD
 Luxembourg: Nouvelle cohorte avec SHARE

50. Methods
VERITAS
(Questionnaire on
regular destinations)
VERITAS
(Questionnaire on
regular destinations)
Canada LuxembourgFrance
Existing
questionnaires (ex:
individual SES)
Existing
questionnaires (ex:
individual SES)
Existing
questionnaires (ex:
individual SES)
Novel GPS/Accelerometry mobility protocol
Novel qualitative assessment of place experience
Existing GIS Existing GIS Existing GIS
NOVEL PROCEDURES TO BE
SHARED AND APPLIED TO
ALL SETTINGS, DRAWING
ON EXISTING EXPERTISE IN
DIFFERENT SETTINGS
EXAMPLES OF EXISTING
COMMON RESSOURCES IN
ALL SETTINGS (Need for
cross-validation of DB to
ensure comparability)
VERITAS
QUESTIONNAIRE
(Activity spaces)
EXAMPLES OF
EXPERTISE/TOOLS EXISTING
IN ONE SETTING TO BE
EXTENDED TO OTHER
SETTINGS
MULTISENSOR
PLATFORM
MULTISENSOR
PLATFORM
MULTISENSOR DEVICE
AND SERVER
PLATFORM
QUALITATIVE
ASSESSMENT OF
MOBILITY
QUALITATIVE
ASSESSMENT OF
MOBILITY
QUALITATIVE
ASSESSMENT OF
MOBILITY
TOOLS/PROCEDURES SHARING CONFIGURATIONS
Novel spatio-temporal modelling

51. Data
 Mobility assessment will resort to:
• Activity space questionnaires
• Continuous 7-days monitoring of location
• Physical activity using wearable sensors
• Qualitative assessment of participants’ experiences
and meanings of his/her activity space, mobility, and
home territories.

52. Data
 Behavioural outcomes of focus:
• Active living (including active transportation, walking
and sedentary behaviour)
• Social participation
• Spatial behaviour (activity space, modes of
transportation, relation to places)
 GIS for environmental exposure measures

53. Analyses
 Liens entre contextes urbains (SIG), mobilité, activité
physique, participation sociale

54. Conclusion
“Design for the young, and you
exclude the old;
design for the old and you
include everyone”
Bernard Isaacs, in G. Miller, G. Harris and I. Ferguson,
“Mobility Under Attack”.

55. Thank you!
www.SPHERE Lab .org
Contact: yan.kestens@umontreal.ca