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Crossing guard presence: Impact on active transportation and injury prevention
... These studies considered SES at the level of the neighbourhood, school, and/or household. The most common method of operationalizing SES was the percentage of the school population eligible for free and/or reduced lunch programs (n = 14) (Bungum et al., 2014;Ginja et al., 2017;Gutierrez et al., 2014;Harvey et al., 2015;Hooshmand et al., 2014;Huang et al., 2018;McDonald et al., 2013McDonald et al., , 2014McLaughlin and Glang, 2010;Mendoza et al., 2011Mendoza et al., , 2012Mendoza et al., , 2017Rodriguez et al., 2019;Sirard et al., 2015), followed by parental SES as measured using either the highest level of parent education, income, and/or employment status (n = 11) (Crawford and Garrard, 2013;Ducheyne et al., 2013Ducheyne et al., , 2014Faulkner et al., 2014;Goodman et al., 2016;Ji et al., 2017;Lucken et al., 2018;Sayers et al., 2012;Sevil et al., 2019;Stewart et al., 2014;Vanwolleghem et al., 2014). Twenty-four papers reported SES at some level, but did not consider SES as an independent variable in models (Bungum et al., 2014;Buttazzoni et al., 2019;Christiansen et al., 2014;Crawford and Garrard, 2013;Ginja et al., 2017;Gutierrez et Malakellis et al., 2017;McLaughlin and Glang, 2010;McMinn et al., 2012;Mendoza et al., 2011Mendoza et al., , 2012Mendoza et al., , 2017Rodriguez et al., 2019;Sayers et al., 2012;Stewart et al., 2014;Vanwolleghem et al., 2014;Verhoeven et al., 2016;Villa-González et al., 2015. ...
... The most common method of operationalizing SES was the percentage of the school population eligible for free and/or reduced lunch programs (n = 14) (Bungum et al., 2014;Ginja et al., 2017;Gutierrez et al., 2014;Harvey et al., 2015;Hooshmand et al., 2014;Huang et al., 2018;McDonald et al., 2013McDonald et al., , 2014McLaughlin and Glang, 2010;Mendoza et al., 2011Mendoza et al., , 2012Mendoza et al., , 2017Rodriguez et al., 2019;Sirard et al., 2015), followed by parental SES as measured using either the highest level of parent education, income, and/or employment status (n = 11) (Crawford and Garrard, 2013;Ducheyne et al., 2013Ducheyne et al., , 2014Faulkner et al., 2014;Goodman et al., 2016;Ji et al., 2017;Lucken et al., 2018;Sayers et al., 2012;Sevil et al., 2019;Stewart et al., 2014;Vanwolleghem et al., 2014). Twenty-four papers reported SES at some level, but did not consider SES as an independent variable in models (Bungum et al., 2014;Buttazzoni et al., 2019;Christiansen et al., 2014;Crawford and Garrard, 2013;Ginja et al., 2017;Gutierrez et Malakellis et al., 2017;McLaughlin and Glang, 2010;McMinn et al., 2012;Mendoza et al., 2011Mendoza et al., , 2012Mendoza et al., , 2017Rodriguez et al., 2019;Sayers et al., 2012;Stewart et al., 2014;Vanwolleghem et al., 2014;Verhoeven et al., 2016;Villa-González et al., 2015. Only five reported significant differences in AST interventions in relation to SES (Arsenio et al., 2018;Collins and Kearns, 2010;Harvey et al., 2015;Mammen et al., 2014a;McDonald et al., 2014); whereas, 13 papers reported no significant differences according to SES (Chen et al., 2018;Ducheyne et al., 2013Ducheyne et al., , 2014Faulkner et al., 2014;Goodman et al., 2016;Hinckson and Badland, 2016;Love et al., 2019;Lucken et al., 2018;Mammen et al., 2014b;McDonald et al., 2013;Sahlqvist et al., 2019;Sevil et al., 2019;Sirard et al., 2015). ...
... Of the 32 papers, 15 papers collected information related to ethnicity and/or controlled for it in their analysis, however, they did not analyse it as an independent variable (Bungum et al., 2014;Christiansen et al., 2014;Ducheyne et al., 2014;Ginja et al., 2017;Goodman et al., 2016;Gutierrez et al., 2014;Hoelscher et al., 2016;Hooshmand et al., 2014;Ji et al., 2017;Mandic et al., 2018aMandic et al., , 2018bMcLaughlin and Glang, 2010;Mendoza et al., 2012;Rodriguez et al., 2019;Stewart et al., 2014). Seven studies found that ethnicity was not significant in predicting AST behaviors (Huang et al., 2018;McDonald et al., 2013McDonald et al., , 2014Østergaard et al., 2015;Sahlqvist et al., 2019;Sayers et al., 2012;Sirard et al., 2015). ...
Introduction
Trends over the last half century have shown that fewer children today are engaging in active modes of travel to and from school than in previous generations. Interventions promoting active school travel (AST) can be effective at reversing these trends and increasing rates of AST among children. This paper aims to explore (1) how studies of AST interventions have considered or framed multiple equity factors, namely those related to gender, socioeconomic status (SES), and ethnic background, in the design and evaluation of AST interventions, and (2) to what extent studies of AST interventions report these equity considerations in their analyses, outcomes, programming, and discussions.
Methods
Six databases were used (BIOSIS Previews, GeoBase, PubMed, SCOPUS, SPORTDiscus, and Web of Science) to obtain AST literature published between 2010 and 2019 from around the world. The inclusion criteria applied in this review included a focus on an AST intervention for children (aged 5–19 years), quantitative results, and a primary outcome related to AST. A total of 69 papers were included in the review.
Results
Across AST intervention studies, equity considerations were scarcely reported. Among the explicit mentions, gender and socioeconomic status were reported most often compared to ethnic background. Some papers reported differential effects among groups. Gender, SES, and ethnic background were, when reported, generally considered as variables that were controlled for within study samples.
Conclusions
Suggestions to address equity within studies of AST interventions include reporting equity considerations made throughout the intervention and its evaluation in the published article. Using and reporting equity frameworks to develop AST interventions and conducting sub-group analyses during evaluation allows for greater assessment of equity effects and improved utility and applicability of the AST intervention. Ensuring the integration of equity into AST literature is needed to support evidence-based and equitable practices.
... After removal of 776 duplicates, 1143 articles were screened. Nine relevant studies evaluating seven unique interventions were included in this review [44][45][46][47][48][49][50][51][52]. ...
... Additional strong ratings were found in the sections "confounders", "data collection methods", "withdrawals/drop-outs", and "analyses". In the section "confounders", only one study [48] did not report adjustments. The other eight studies [44][45][46][47][49][50][51][52] reported adjustments for at least two up to eight out of ten different covariates (i.e., age, distance from home to school, sex/gender, AST, BMI, race, bike score, neighbourhood disorder, attendance, accelerometer wear time). ...
... However, group differences at baseline were only absent in two studies [44,51]. In the section "data collection methods", three studies were rated as weak [45,46,51], three as moderate [47,48,52], and three as strong [44,49,50]. Referring to the section "withdrawals/drop-outs", six studies declared drop-outs [44,46,47,[50][51][52] and five studies had low retention rates [45,48,49,51,52]. ...
Background
Promoting cycling to school may benefit establishing a lifelong physical activity routine. This systematic review aimed to summarize the evidence on strategies and effects of school-based interventions focusing on increasing active school transport by bicycle.
Methods
A literature search based on “PICo” was conducted in eight electronic databases. Randomized and non-randomized controlled trials with primary/secondary school students of all ages were included that conducted pre-post measurements of a school-based intervention aimed at promoting active school travel by bicycle and were published in English between 2000 and 2019. The methodological quality was assessed using the “Effective Public Health Practice Project” tool for quantitative studies. Applied behavior change techniques were identified using the “BCT Taxonomy v1”. Two independent researchers undertook the screening, data extraction, appraisal of study quality, and behavior change techniques.
Results
Nine studies investigating seven unique interventions performed between 2012 and 2018 were included. All studies were rated as weak quality. The narrative synthesis identified 19 applied behavior change techniques clustered in eleven main groups according to their similarities and a variety of 35 different outcome variables classified into seven main groups. Most outcomes were related to active school travel and psychosocial factors, followed by physical fitness, physical activity levels, weight status, active travel and cycling skills. Four studies, examining in total nine different outcomes, found a significant effect in favor of the intervention group on bicycle trips to school (boys only), percentage of daily cycling trips to school, parental/child self-efficacy, parental outcome expectations, moderate-to-vigorous intensity physical activity (total, from cycling, before/after school), and total basic cycling skills. Seven of these outcomes were only examined in two studies conducting the same intervention in children, a voluntary bicycle train to/from school accompanied by adults, including the following clustered main groups of behavior change techniques: shaping knowledge, comparison of behavior, repetition and substitution as well as antecedents.
Conclusions
The applied strategies in a bicycle train intervention among children indicated great potential to increase cycling to school. Our findings provide relevant insights for the design and implementation of future school-based interventions targeting active school transport by bicycle.
Trial registration
This systematic review has been registered in the international prospective register of systematic reviews “PROSPERO” at (registration number: CRD42019125192).
... Finally, 23 intervention studies related to active transportation to school were included in this review. -Gonzalez et al., 2016), whereas nine studies included adolescents from secondary schools (aged 13 to 18) (Buliung et al., 2011;Christiansen et al., 2014;Gutierrez et al., 2014;Hunter et al., 2015;Mammen et al., 2014;McDonald et al., 2014;McDonald et al., 2013;Sirard et al., 2015;Stewart et al., 2014). ...
... Regarding study design, three studies were rated as strong because randomized controlled trial designs were used (Christiansen et al., 2014;Ducheyne et al., 2014;Mendoza et al., 2011). However, most study designs were moderately rated using quasi-experimental designs (two groups pre + post (Bungum et al., 2014;Coombes and Jones, 2016;Crawford and Garrard, 2013;Goodman et al., 2016;Gutierrez et al., 2014;Hoelscher et al., 2016;McDonald et al., 2014;McDonald et al., 2013;McMinn et al., 2012;Villa-Gonzalez et al., 2016) or one group pre + post (Buckley et al., 2013;Buliung et al., 2011;Hunter et al., 2015;Kong et al., 2010;Mammen et al., 2014;Ostergaard et al., 2015;Sayers et al., 2012;Sirard et al., 2015;Stewart et al., 2014;Vanwolleghem et al., 2014 There were no differences in frequency of cycling to and from school (minutes/week) between pre-postfollow-up and between groups. ...
... week 4: 12%). Regarding the primary outcome assessment method, eleven studies were rated as strong, since they reported evidence of validity and reliability for the measurement instruments (Christiansen et al., 2014;Coombes and Jones, 2016;Crawford and Garrard, 2013;Ducheyne et al., 2014;Gutierrez et al., 2014;Hoelscher et al., 2016;Mammen et al., 2014;McMinn et al., 2012;Mendoza et al., 2011;Sayers et al., 2012;Vanwolleghem et al., 2014). In three of these, objective measurement methods were used (e.g., accelerometer (McMinn et al., 2012;Sayers et al., 2012) and pedometer (Vanwolleghem et al., 2014)). ...
Active commuting to school has been recognized as a potential avenue to increase physical activity in children and adolescents. However, active commuting to school has declined over time, and interventions are needed to reverse this trend. The main aim in the current study was to update a previous systematic review on interventions focused on active travel to school, following the same methodology and addressing the quality and effectiveness of new studies detected in the more recent scientific literature. A systematic review was conducted to identify intervention studies of active commuting to school published from February 2010 to December 2016. Five electronic databases and a manual search were conducted. Detailed information was extracted, including a quantitative assessment comparing the effect sizes, with Cohen's d, and a qualitative assessment using the Evaluation of Public Health Practice Projects tool. We identified 23 interventions that focused on active commuting to school. Among the 23 interventions, three were randomized control trials, 22 had a pre/post design, and 12 used control groups. Most interventions reported a small effect size on active commuting to school (14/23) (d: from -1.45 to 2.37). The quality assessment was rated as weak in most studies (21/23). Government funding continues investing in public policies to promote active commuting to school. However, even though seven years have passed since the last systematic review, research with high quality designs with randomization, greater sample size, and the use of valid and reliable instruments are needed.
... Parents of older students, those living <3 km away from school, attending urban and suburban schools, and attending medium-SES schools were more likely to report less driving. deploying crossing guards on travel behaviors [37]. Included studies assessed AST in a variety of ways including classroom hand-up surveys [17,18,20,34,42,43,48], child surveys and diaries [32,33,41,45,46,[49][50][51], parent surveys [19,30,[34][35][36]38], direct observation [29,31,32,37,48], using a swipe card technology [40] or by recording accelerometer steps taken during the school journey [44]. ...
... deploying crossing guards on travel behaviors [37]. Included studies assessed AST in a variety of ways including classroom hand-up surveys [17,18,20,34,42,43,48], child surveys and diaries [32,33,41,45,46,[49][50][51], parent surveys [19,30,[34][35][36]38], direct observation [29,31,32,37,48], using a swipe card technology [40] or by recording accelerometer steps taken during the school journey [44]. One study compared accelerometrymeasured PA among participants in a WSB and nonparticipants [47]. ...
... In analyses that included the blinding component of the EPHPP tool, only three studies were rated as "moderate" [32,39,45], and the remainder were rated as "weak". In a sensitivity analysis that excluded the blinding component, study quality was rated as weak for 21 interventions [19, 20, 29-31, 33, 34, 36, 38, 40-43, 46, 48-51], moderate for six interventions [17,18,35,37,44,47], and strong for three interventions [32,39,45]. While our review included some randomized controlled trials, most individual studies were rated as "weak" and very serious limitations in the design and implementation of interventions were noted, as mentioned above. ...
Background
Active school transport (AST) is a promising strategy to increase children’s physical activity. A systematic review published in 2011 found large heterogeneity in the effectiveness of interventions in increasing AST and highlighted several limitations of previous research. We provide a comprehensive update of that review. Methods
Replicating the search of the previous review, we screened the PubMed, Web of Science, Cochrane, Sport Discus and National Transportation Library databases for articles published between February 1, 2010 and October 15, 2016. To be eligible, studies had to focus on school-aged children and adolescents, include an intervention related to school travel, and report a measure of travel behaviors. We assessed quality of individual studies with the Effective Public Health Practice Project quality assessment tool, and overall quality of evidence with the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. We calculated Cohen’s d as a measure of effect size. ResultsOut of 6318 potentially relevant articles, 27 articles reporting 30 interventions met our inclusion criteria. Thirteen interventions resulted in an increase in AST, 8 found no changes, 4 reported inconsistent results, and 5 did not report inferential statistics. Cohen’s d ranged from −0.61 to 0.75, with most studies reporting “trivial-to-small” positive effect sizes. Three studies reported greater increases in AST over longer follow-up periods and two Safe Routes to School studies noted that multi-level interventions were more effective. Study quality was rated as weak for 27/30 interventions (due notably to lack of blinding of outcome assessors, unknown psychometric properties of measurement tools, and limited control for confounders), and overall quality of evidence was rated as low. Evaluations of implementation suggested that interventions were limited by insufficient follow-up duration, incomplete implementation of planned interventions, and limited access to resources for low-income communities. Conclusions
Interventions may increase AST among children; however, there was substantial heterogeneity across studies and quality of evidence remains low. Future studies should include longer follow-ups, use standardized outcome measures (to allow for meta-analyses), and examine potential moderators and mediators of travel behavior change to help refine current interventions. Trial registrationRegistered in PROSPERO: CRD42016033252
... For instance, the Danish program "Tryg og Sikker Skole cykling" (Safe and secure cycling to school) includes changes in the cycling infrastructure near schools (environmental), transfer of knowledge and shaping the knowledge (informational) as well as demonstration of the behavior, social comparison, repetition and substitution, reward and threat, feedback and monitoring concerning the desirable behavior (behavioral) (Østergaard et al., 2015). Other AST programs consist of practical cycling exercises, training courses or cycle games and parental assisted homework tasks (Ducheyne et al., 2014), accompanied bicycle trains (Huang et al., 2018;Mendoza et al., 2017), theoretical and practical activities in the classroom by teachers (Villa-González et al., 2016;2017) or awareness campaigns (Gutierrez et al., 2014). ...
... Most bicycle education programs for children are delivered in schools with the target group being between 8 and 14 years of age (Schönbach et al., 2020;Sersli et al., 2019) or not specifically to adolescents (Gutierrez et al., 2014, age 0 to 17). The "Bike Ed" program comprises teaching materials that mediate cycling skills and knowledge to reduce bicycle-related injuries (Carlin et al., 1998). ...
Background
Over the last two decades, bicycling as a mode for transportation has declined by 64% among 16- to 20-year-old adolescents in Switzerland, the largest decrease of any age group. The aim of this study was to evaluate the short-term effects of a bicycle training on adolescents’ cycling skills. In addition, the study investigated whether there is a relationship between school distance, mode of transport, bicycle use and cycling skills.
Methods
77 adolescents (Mean age = 17.1 ± 0.8 years) were assigned to the intervention group (n = 48) or control group (n = 29). In both groups, a validated practical cycling skills test was performed at baseline and 2 weeks after baseline. The intervention group performed 2 h of bicycle training one week after the baseline test. A questionnaire was used to determine bicycle use, mode of transportation and distance to school. Due to Covid-19 school closures, only an online questionnaire was administered at 6-month follow-up. To analyze the effects of cycling training on cycling skills, multiple linear regression models adjusted for age, gender, and baseline cycling skills were applied.
Results
Compared to the control group, the total cycling skills increased in the intervention group (β = 4.54, [0.89 : 8.19], p = 0.02), as well as riding over a wooden plank with a ladder profile (β = 1.14, [0.08 : 2.19], p = 0.04) and controlled riding over a step (β = 1.48, [0.63 : 2.33], p ≤ 0.001). An association was found between bicycle use, mode of transportation, and cycling skills (p < 0.05). In contrast, no association could be found for school distance.
Conclusion
Cycling training improved adolescents’ cycling skills in the short term. Cycling skills correlated with bicycle use and mode of transportation.
... The first empirical studies addressing behavioral changes in children emerged in Medicine-related publications in the 2010s, with the evaluation of established programs to increase children's active commuting to school and decrease traffic congestion, namely the Walking School Bus (Mendoza et al. 2011;Sayers et al. 2012) and school travel plans (Hinckson and Badland 2011). These topics were further incorporated by transport-related academic journals, which assessed the health benefits of active transport and injury reduction that were brought by cycle training courses (Ducheyne et al. 2014), increased crossing guard presence (Gutierrez et al. 2014), and school-based interventions (Christiansen et al. 2014). These narratives were commonly embedded with the belief that "reducing this dependence [of auto transportation] at an early age may establish a lifelong pattern of active transportation" (Sirard et al. 2015, p. 29). ...
... These considerations suggest possible lessons for the evaluation of child-centered interventions in the transport domain, particularly with regard to the role of perceptions and early childhood in behavioral changes involving school-based interventions towards sustainable transportation. First, the perceptions seem to indicate triggers for behavior change and might be the starting point for future measures, converging with the suggestion brought by Gutierrez et al. (2014) regarding the "prioritization towards engaging in and acknowledging safety before physical activity" (p. 116) to promote active transportation with children. ...
This manuscript seeks to evaluate changes in the travel behavior of young children (5–6 y/o.) and their caregivers following the implementation of a 4-month program in public preschools in São Paulo (Brazil) with a high prevalence of low-income immigrants. The program was developed around two intervention types: i) weekly inquiry sessions about urban mobility through the Philosophy with Children approach and ii) bimonthly outdoor walking activities in the surroundings of schools. In this way, it was possible to observe positive changes in the perceptions of children's statements and in the social norms of their caregivers about transportation, as well as significant modal shifts as reported by caregivers towards sustainable mobility, which were evaluated using difference-in-differences and time-series analyses.
Besides the identification of changes in the behavior of adult caregivers through child-centered intervention types, this empirical research enabled unraveling the effect of the proposed measures according to the child's gender, nationality, and level of social vulnerability, including the significant modal shifts towards walking and cycling identified among caregivers of boys and out of car and motorcycle among those of native children, which were significant both in post and follow-up measures.
In addition to contributions to the evaluation of school-based interventions with data from developing countries, the discussions presented in this paper intend to provide insights into the role of early childhood and perceptions in behavioral changes towards sustainable transport.
... Funding has recently been allocated to the Safe Routes to School programs by the U.S. federal government's transportation bill (Ferrell 2019;J. Lee, Abdel-Aty, and Rahman 2018) and studies have evaluated safe and active transportation modes for school-aged children (Ermagun and Levinson 2017;Ermagun and Samimi 2015;Gutierrez et al. 2014). However, motor vehicle crashes continue to be a leading cause of death among children 15 years and younger (National Center for Statistics and Analysis 2021). ...
... The presence of a crossing guard may have some limited positive impact on active transportation to school. A study by Gutierrez et al. (2014) showed that the presence of paid crossing guards had no measurable improvement in the rate of active transport or parents' attitude towards walking/cycling, however it was observed that children were more likely to follow designated safe routes when a professional crossing guard was present. It is feasible to believe that the long-effect of children sticking to designated safe routes may have a measurable improvement in safety, which may positively influence parents' attitude towards the risk of active travel, and therefore increase rates of active travel to school. ...
Active transport to school amongst high school students is very low in Australia. Multiple studies have shown that the distance between home and school, is a key factor in predicting the likelihood of cycling. Parental concerns over traffic collisions are also a strong contributing factor. Efforts to increase walking/cycling rates have focused on educational campaigns, rather than making improvements to the built form. This study quantitatively assessed seven Adelaide metropolitan high schools in order to determine their suitability for active transport, establish straightforward methods for ranking schools, and identify targeted areas for improvement. The siting of the schools has been shown to be the most important factor, as it dramatically affects the two most important factors of distance to be travelled, and traffic collisions. Five of the seven schools scored favourably in terms of travel distance, with two schools lacking connection with residential areas. Generally, all schools in the study were located very close to highly trafficked roads, with high rates of crashes. Casualties amongst high school children near schools are low, most likely as a result of low active transportation rates, rather than a safe environment. If active transport rates increase substantially without corresponding improvements in the built form, casualties would be likely to increase. In order to achieve a substantial increase in walking/cycling to school, future schools should be sited close to high-density residential areas, and away from busy, high-speed main roads.
... Interestingly, although increased crossing guard presence around school zones should increase safe behavior [56], this study finds an increased likelihood of injury crashes by other vehicles at locations where crossing guards controlled the traffic. This finding certainly raises concerns about the competencies and/or effectiveness of crossing guard placements in school zones. ...
Although the school bus is considered a safe form of transportation, school bus crashes are a major safety concern. School bus crashes are a result of driver error of either the at-fault school bus or another at-fault vehicle (where the school bus is not at fault). To examine the risk factors associated with school bus related crashes and crash outcomes, this study segments and develops two binary logit models for each school bus crash type. A total of 1702 school bus related crashes recorded between 2009 and 2016 were used to estimate the model. According to the model results, sideswipe collisions were less likely to result in injury outcomes for at-fault school buses than rear-end and side-impact collisions. Speeding, driving impaired or under the influence, and negotiating a curve all have significant positive associations with injury outcomes in not-at-fault school bus crashes. This study’s practical implications include enforcing the school bus safe driving guidelines, training programs for school bus drivers that include elements of nonroutine trips, training for crossing guards, and awareness programs for drivers of other vehicles to instill safe driving practices around school buses.
... These interventions typically involved modifying the built or natural environment to create opportunities for physical activity and social connection. [91][92][93] Alternatively, interventions used physical activity as an opportunity to promote social connection. 94,95 These multifaceted interventions seem to provide the most impactful solutions, as they can improve both physical activity and social connectedness among children and youth. ...
Introduction
The rise in sedentary behaviour, coupled with the decline in overall mental health among Canadian children and youth in recent decades, demonstrates a clear need for applied research that focusses on developing and evaluating cross-disciplinary interventions. Outdoor spaces provide opportunities for physical activity and social connectedness, making them an ideal setting to address these critical health concerns among children and youth.
Methods
We conducted a rapid review of peer-reviewed (n = 3096) and grey literature (n = 7) to identify physical activity and/or social connectedness outdoor space interventions targeted at children and youth (19 years and under) in Australia and New Zealand, Canada, Europe and the United States. We determined if interventions were effective by analyzing their research design, confidence intervals and reported limitations, and then conducted a narrative synthesis of the effective interventions.
Results
We found 104 unique studies, of which 70 (67%) were determined to be effective. Overall, 55 interventions targeted physical activity outcomes, 10 targeted social connectedness outcomes and 5 targeted both. Play (n = 47) and contact with nature(n = 25) were dominant themes across interventions, with most taking place in a school or park. We report on the identifying features, limitations and implications of these interventions.
Conclusion
The incorporation of natural and play-focussed elements into outdoor spaces may be effective ways to improve physical activity and social connectedness. There is a considerable need for more Canadian-specific research. Novel methods, such as incorporating smartphone technology into the design and evaluation of these interventions, warrant consideration.
... One such safety implementation is the Crossing Guard Training programs. Crossing guards have shown to improve the safety for children walking to school (Gutierrez et al., 2014;Rothman et al., 2015). Another intervention is establishing The Walking School Bus, a form of adult supervised commuting that helps establish safe routes for children to walk to and from school (SRTS Guide, 2019). ...
... • Less traffic around the school during pick-up and drop-off times [19][20][21] Peer review papers 18,19,3,19-21 ...
This Rapid Review provides an overview of current research evidence and other related literature on the value of physical activity and play for children. Both forms of activity have
declined markedly in recent decades to the extent that only a minority of children in Australia meet the recommended guideline of 60 minutes of moderate physical activity per
day. Emerging evidence indicates that these late 20th century — 21st century societal changes have been detrimental to children’s development, their current health and, in all
probability, their future health prospects. We illustrate these latter points in Part 1 of this review with data gathered from within the Australian Capital Territory, and in some cases
across Australia, with a particular focus on the emergence of metabolic, cardiovascular and mental health problems in young people (i.e. those aged below 25 years of age). In this
regard the review is timely.
These issues were discussed at an International Forum, Shaping Spaces for Gen-Z, held in Canberra in March 2017, to identify priority actions for change. Provision for safe active
travel to school was strongly endorsed as the highest priority, best value-for-money action from this Forum.
Unlike a full systematic review, this review has, in the interests of timeliness and urgency, used an abbreviated appraisal process for the individual items of evidence retrieved. That
said, a large portion of the research reviewed is based on several full systematic reviews that were conducted within the review period. The majority of the further evidence gathered
comes from peer-reviewed papers published in leading research Journals. Individual items of evidence have not been graded nor has full quality appraisal been undertaken
(apart from that already carried out in the systematic reviews retrieved). This report provides an update of current knowledge on physical activity policy and provision for Australian school children, including a special focus on safe active school travel. It aims to support policy makers in their decision-making. We hope that it provides a basis for future policy planning and development.
... Engineering strategies such as the installation of sidewalks, bicycle lanes, and safe crossings ( DiMaggio et al., 2015) to increase the accessibility for and safety of AST trips are also frequently employed. Other examples include awareness campaigns in the form of education curriculums that promote AST by improving children's safety knowledge (e.g., Bovis et al., 2016), and enforcement strategies such as crossing guard programs which can be used to support AST through increasing the visibility of trip safety (e.g., Gutierrez et al., 2014). ...
Introduction: Active school travel (AST) can be a viable way to increase children's low levels of daily physical activity by promoting opportunities to walk and wheel. To promote AST in Canada, School Travel Plan (STP) programs have been implemented throughout the country. The STP program is a comprehensive 2-year intervention that is facilitated by a committee of community and school partners who implement education, encouragement, enforcement, and engineering initiatives at their school to support AST. Methods: This study examines the impact of the STP program on children's and parents' perceptions of AST barriers, and children's engagement in AST from pre-to post-intervention. In total, 13 elementary schools representing a total sample of 4720 parents and 2084 children from across Southwestern Ontario, Canada were involved in this program evaluation. Results: Findings indicate that the STP program was successful in significantly reducing children's and parents' perceptions of AST barriers. An analysis of travel behaviour found the STP program was limited in affecting behavioural change, as the results show an insignificant trend of increasing AST use and decreasing car use. Conclusions: Changing perceptions of AST barriers suggests that the STP intervention has the potential to change intentions and motivation for parents and children, which may lead to significant increases in future AST. This study recommends that future interventions focus on parental education and empowerment initiatives to reduce an apparent intention-behaviour gap that exists in their AST decision making process.
... A recent pre-post intervention study done in Toronto, Canada, found a null effect of school crossing guards on child PMVCs (Rothman et al., 2015a). There is also conflicting evidence regarding whether or not the implementation of school crossing guards is associated with more children walking (Rothman et al., 2013b;Gutierrez et al., 2014). In the absence of good pedestrian and vehicle volume denominators, it is impossible to determine if there is a true negative or positive effect of crossing guards on child PMVCs. ...
Background:
Child pedestrian-motor vehicle collisions (PMVCs) have decreased in Canada in the past 20 years. Many believe this trend is explained by the rise in automobile use for all travel. Initiatives to increase walking to school need to consider PMVC risk. Potential risk factors related to walking to school, the built environment and social factors were examined for schools with historically high child PMVC rates.
Methods:
Child PMVCs (age 4-12 years) from 2000 to 2013 and built environment features were mapped within school attendance boundaries in the City of Toronto, Canada. Case and control schools were in the highest and lowest PMVC quartiles respectively. Observational counts of travel mode to school were conducted. Logistic regression evaluated walking to school, built environment and social risk factors for higher PMVC rates, stratified by geographic location (downtown vs. inner suburbs).
Results:
The mean PMVC rates were 18.8/10,000/year (cases) and 2.5/10,000/year (controls). One-way street density (OR=4.00), school crossing guard presence (OR=3.65) and higher social disadvantage (OR=1.37) were associated with higher PMVCs. Higher residential land use density had a protective effect (OR=0.56). More walking was not a risk factor. While several built environment risk factors were identified for the inner suburbs; only social disadvantage was a risk factor within older urban neighbourhoods.
Conclusions:
Several modifiable environmental risk factors were identified for child PMVCs. More walking to school was not associated with increased PMVCs after controlling for the environment. School social disadvantage was associated with higher PMVCs with differences by geographic location. These results have important implications for the design of roadways around schools.
... Environmental changes such as traffic calming and pedestrian management (e.g., diverting to pedestrian bridges/tunnels) are highly effective but complicated and costly to implement (Jones et al., 2005; Rothman et al., 2014). Increased supervision of children by parents, school officials, or crossing guards also appear to be effective (Barton and Schwebel, 2007; Gutierrez et al., 2014; Yeaton and Bailey, 1983), but research suggests parents rarely instruct their own children in pedestrian settings (Zeedyk and Kelly, 2003) and hiring school officials or law enforcement officials to protect child pedestrians is costly. A third alternative is to train children themselves to cross streets more safely. ...
Child pedestrian injuries are a leading cause of mortality and morbidity across the United States and the world. Repeated practice at the cognitive-perceptual task of crossing a street may lead to safer pedestrian behavior. Virtual reality offers a unique opportunity for repeated practice without the risk of actual injury. This study conducted a pre-post within-subjects trial of training children in pedestrian safety using a semi-mobile, semi-immersive virtual pedestrian environment placed at schools and community centers. Pedestrian safety skills among a group of 44 seven- and eight-year-old children were assessed in a laboratory, and then children completed six 15-minute training sessions in the virtual pedestrian environment at their school or community center following pragmatic trial strategies over the course of three weeks. Following training, pedestrian safety skills were re-assessed. Results indicate improvement in delay entering traffic following training. Safe crossings did not demonstrate change. Attention to traffic and time to contact with oncoming vehicles both decreased somewhat, perhaps an indication that training was incomplete and children were in the process of actively learning to be safer pedestrians. The findings suggest virtual reality environments placed in community centers hold promise for teaching children to be safer pedestrians, but future research is needed to determine the optimal training dosage.
... The pedestrian environment may be modified in a number of ways to promote safe pedestrian travel, which include speed restrictions, pedestrian-only areas, traffic signals, and adult crossing guards. It has been demonstrated that an increased presence of road safety measures generally increases the number of children walking to school [18], and there is specific evidence from qualitative parental interviews and cross-sectional observational studies that the presence of a crossing guard increases pedestrian journeys to school [19,20], although some debate exists [21]. This suggests that there is a widespread assumption amongst parents, and the wider public, that crossing guards have a favorable influence on traffic behaviour, and on pedestrian deaths, though this notion has largely been unchallenged. ...
Background:
The presence of school crossing guards has been associated with more walking and more pedestrian-motor vehicle collisions (PMVCs) in area-level cross-sectional analyses. The objectives of the study were to (1) Determine the effect on PMVC rates of newly implemented crossing guards in Toronto, Canada (2) Determine where collisions were located in relation to crossing guards throughout the city, and whether they occurred during school travel times.
Methods:
School crossing guards with 50 m buffers were mapped along with police-reported child PMVCs from 2000-2011. (1) A quasi-experimental study identified all age collision counts near newly implemented guards before and after implementation, modeled using repeated measures Poisson regression adjusted for season and built environment variables. (2) A retrospective cohort study of all child PMVCS throughout the city to determine the proportions of child PMVCs which occurred during school travel times and at guard locations.
Results:
There were 27,827 PMVCs, with 260 PMVCs at the locations of 58 newly implemented guards. Repeated measures adjusted Poisson regression found PMVCs rates remained unchanged at guard locations after implementation (IRR 1.02, 95 % CI 0.74, 1.39). There were 568 guards citywide with 1850 child PMVCs that occurred at guard locations. The majority of child PMVCs occurred outside school travel times (n = 1155, 62 %) and of those that occurred during school travel times, only 95 (13.7 %) were at a guard location.
Conclusions:
School crossing guards are a simple roadway modification to increase walking to school without apparent detrimental safety effects. Other more permanent interventions are necessary to address the frequency of child PMVCs occurring away from the location of crossing guards, and outside of school travel times.
This manuscript seeks to evaluate changes in the travel behavior of young children (5-6 y/o.) and their caregivers following the implementation of a 4-month program in public preschools in São Paulo (Brazil) with a high prevalence of low-income immigrants. The program was developed around two intervention types: i) weekly inquiry sessions about urban mobility through the Philosophy with Children approach and ii) bimonthly outdoor walking activities in the surroundings of schools. In this way, it was possible to observe positive changes in the perceptions of children’s statements and in the social norms of their caregivers about transportation, as well as significant modal shifts of caregivers towards sustainable mobility, which were evaluated using difference-in-differences and time-series analyses. Besides the identification of changes in the behavior of adult caregivers through child-centered intervention types, this empirical research enabled unraveling the effect of the proposed measures according to the child’s gender, nationality, and level of social vulnerability, including the significant modal shifts towards walking and cycling identified among boys and out of car and motorcycle among native children, which were significant both in post and follow-up measures.In addition to contributions to the evaluation of school-based interventions with data from developing countries, the discussions presented in this paper intend to provide insights into the role of early childhood and perceptions in behavioral changes towards sustainable transport.
This chapter discusses active transport to and from school (ATS). The chapter starts with an overview of definitions, international data on prevalence and trends, and correlates of active transport to and from school. A subsequent section discusses health effects of active ATS focusing on physical activity, body weight, and cardiorespiratory fitness as well as other benefits. The following section provides an overview of the key intervention studies that have been implemented to encourage active ATS in children and adolescents. Discussion of the effectiveness and quality of those interventions is included. The chapter ends with recommendations for researchers, practitioners, and policy makers for designing and implementation of future active transport to school interventions.
Introduction
La conjugaison d’une augmentation du comportement sédentaire et d’une baisse de la santé mentale globale chez les enfants et les jeunes canadiens dans les dernières décennies est le signe évident que l’on a besoin de recherche appliquée axée sur l’élaboration et l’évaluation d’interventions interdisciplinaires. Les espaces extérieurs offrent des possibilités d’activité physique et d’interactions sociales, ce qui en fait un cadre idéal pour répondre à ces préoccupations essentielles en matière de santé chez les enfants et les jeunes.
Méthodologie
Nous avons procédé à une revue rapide de la littérature évaluée par les pairs (n = 3 096) et de la littérature grise (n = 7) afin de sélectionner les interventions en faveur de l’activité physique et de l’appartenance sociale portant sur les espaces extérieurs et visant les enfants et les jeunes (19 ans ou moins) en Australie et en NouvelleZélande, au Canada, en Europe et aux ÉtatsUnis. Nous avons déterminé si les interventions étaient efficaces en analysant la conception de l’étude, les intervalles de confiance et les limites signalées, puis en réalisant une synthèse narrative des interventions efficaces.
Résultats
Nous avons relevé 104 études, dont 70 (67 %) ont été jugées efficaces. Sur l’ensemble, 55 interventions visaient l’activité physique, 10 visaient l’appartenance sociale et 5 visaient les deux. Le jeu (n = 47) et le contact avec la nature (n = 25) étaient les thèmes dominants dans toutes les interventions, la plupart ayant lieu dans une école ou un parc. Nous rendons compte des caractéristiques, des limites et des conséquences de ces interventions.
Conclusion
L’intégration d’éléments naturels et ludiques dans les espaces extérieurs peut être un moyen efficace d’améliorer l’activité physique et l’appartenance sociale. Il y a un besoin considérable de recherches plus spécifiques au Canada. De nouvelles stratégies, comme l’intégration de la technologie des téléphones intelligents dans la conception et l’évaluation de ces interventions, méritent d’être envisagées.
Unintentional injury is the leading cause of death among children aged 5 to 14 years. The WalkSafe program was developed in response to the number of children admitted to Miami-Dade County, Florida, level-1 trauma centers. WalkSafe was piloted in an initially high-risk neighborhood, which now exhibits a low density of pedestrian crashes. Following countywide implementation of WalkSafe, trauma data exhibit a 78% decrease in pediatric injuries. This article provides a 15-year review of WalkSafe and its role in decreasing pediatric pedestrian injuries in Miami-Dade County. Every year, an alarming number of child pedestrians are injured on the nation's roadways. In Miami-Dade County, Florida, the WalkSafe program aims to reduce pediatric injury through targeted education and multitiered collaboration with community partners. (Am J Public Health. Published online ahead of print November 29, 2018: e1-e3. doi:10.2105/AJPH.2018.304786).
Context:
As children's lifestyles have become increasingly sedentary, active school travel can be a relatively accessible way to increase their daily physical activity. In recent years, several different models of interventions have been utilized to promote children participating in active school travel. This review documents and analyzes the different active school travel intervention methodologies that have been used in North America (Canada or U.S.) by collecting, organizing, and evaluating data relating to all phases of active school travel interventions.
Evidence acquisition:
This systematic review developed a key word search and applied it in six databases (BIOSIS Previews, GeoBase, PubMed, SCOPUS, SPORTDiscus, Web of Science) to gather scholarly literature. A total of 22 studies evaluating children's active school travel interventions in a North American setting (four Canada, 18 U.S.) were identified for the period between January 2010 and March 2017.
Evidence synthesis:
Applying the Safe Routes to School Education, Encouragement, Enforcement, Engineering, Equity, and Evaluation ("6 E's") framework, interventions were thematically assessed for their structure and organization, approaches and methods, and outcomes and discussions. Encouragement and education were the most commonly observed themes within the different methodologies of the studies reviewed. Details relating to intervention approaches and methods were common; whereas data relating to intervention structure and organization received much less attention.
Conclusions:
Kingdon's multiple streams approach was applied to frame the findings for program facilitators and evaluators. Within the multiple streams approach, several considerations are offered to address and potentially improve active school travel intervention conceptualization, partnerships, organization, and evaluation.
Florida has a severe problem with pedestrian and bicyclist fatalities. Recent trends show that Florida’s pedestrian fatality rate is almost double the national average. Traditional safety programs rely on crash data to develop safety campaigns or countermeasures to increase safety. Since crash data are not readily available and a long time has to pass before meaningful data is collected, a “risk score” was developed to measure the behavior of road users at selected sites in Hillsborough and Miami-Dade counties. Surveys were conducted in June-July 2012 in two of the highest pedestrian crash and fatality counties in Florida to collect data and establish baseline conditions. The surveys included opinion surveys of pedestrians and observations of pedestrians and bicyclists, and their interaction with drivers. The locations where the surveys were conducted were selected based on site characteristics including pedestrian treatments or features, crash history, and land use. The two surveys offered insight on the difference between what people know about the law or correct behavior, and what they actually do in reality. Results pinpoint the problems and aid in deciding the focus of safety campaigns and target audience. The risk score showed that the majority of sites exhibited unsafe behavior from pedestrians, bicyclists, and drivers. The risk score has the potential to aid in measuring the effectiveness of a safety campaign launched by the Florida Department of Transportation focused on increasing the awareness on traffic laws. This way, appropriate countermeasures or funds can be selected for the higher ranking sites first.
This study's purpose was to implement a comprehensive program to reduce pedestrian deaths and injuries among pedestrians in a large urban environment. Miami-Dade County, Florida, was selected as the study's focus. High-crash locations were targeted for countermeasure implementation and analysis. With pedestrian crash data (1996-2001), four zones within the county were identified as having abnormally high pedestrian crash experience. On the basis of crash characteristics and pedestrian factors (age, ethnicity), 16 education, enforcement, and engineering treatments were implemented to reduce pedestrian crashes in the four zones and countywide. A before-and-after study was used with three control groups to evaluate the effects of the pedestrian safety program on pedestrian crashes. A 3-year "after" period was used (2002-2004). Multivariate intervention autoregressive integrated moving average time-series analysis was used, along with nonparametric U-tests to test for statistically significant differences in pedestrian crash experience. Results showed that at the peak of the program effects in 2003 and 2004, the pedestrian safety program reduced countywide pedestrian crash rates by anywhere from 8.5% to 13.3%, depending on which control group was used. These effects translate to approximately 180 fewer crashes annually in the county, or 360 pedestrian crashes reduced for 2003 and 2004 combined, based on the more conservative 8.5% crash reduction. Countywide, the greatest crash reductions were found among children and adults as a result of the program. Educational and other measures to reduce crashes involving older pedestrians showed no effect. A number of lessons learned were identified for future program implementation.
Background:
The child active transportation literature has focused on walking, with little attention to risk associated with increased traffic exposure. This paper reviews the literature related to built environment correlates of walking and pedestrian injury in children together, to broaden the current conceptualization of walkability to include injury prevention.
Methods:
Two independent searches were conducted focused on walking in children and child pedestrian injury within nine electronic databases until March, 2012. Studies were included which: 1) were quantitative 2) set in motorized countries 3) were either urban or suburban 4) investigated specific built environment risk factors 5) had outcomes of either walking in children and/or child pedestrian roadway collisions (ages 0-12). Built environment features were categorized according to those related to density, land use diversity or roadway design. Results were cross-tabulated to identify how built environment features associate with walking and injury.
Results:
Fifty walking and 35 child pedestrian injury studies were identified. Only traffic calming and presence of playgrounds/recreation areas were consistently associated with more walking and less pedestrian injury. Several built environment features were associated with more walking, but with increased injury. Many features had inconsistent results or had not been investigated for either outcome.
Conclusions:
The findings emphasise the importance of incorporating safety into the conversation about creating more walkable cities.
This article investigates various ways that transportation policy and planning decisions affect public health and better ways to incorporate public health objectives into transport planning. Conventional planning tends to consider some public health impacts, such as crash risk and pollution emissions measured per vehicle-kilometer, but generally ignores health problems resulting from less active transport (reduced walking and cycling activity) and the additional crashes and pollution caused by increased vehicle mileage. As a result, transport agencies tend to undervalue strategies that increase transport system diversity and reduce vehicle travel. This article identifies various win-win strategies that can help improve public health and other planning objectives. Expected final online publication date for the Annual Review of Public Health Volume 34 is March 17, 2013. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
Background:
In 2005, the US Congress allocated $612 million for a national Safe Routes to School (SRTS) program to encourage walking and bicycling to schools. We analyzed motor vehicle crash data to assess the effectiveness of SRTS interventions in reducing school-aged pedestrian injury in New York City.
Methods:
Using geocoded motor vehicle crash data for 168 806 pedestrian injuries in New York City between 2001 and 2010, annual pedestrian injury rates per 10 000 population were calculated for different age groups and for census tracts with and without SRTS interventions during school-travel hours (defined as 7 am to 9 am and 2 pm to 4 pm, Monday through Friday during September through June).
Results:
During the study period, the annual rate of pedestrian injury decreased 33% (95% confidence interval [CI]: 30 to 36) among school-aged children (5- to 19-year-olds) and 14% (95% CI: 12 to 16) in other age groups. The annual rate of school-aged pedestrian injury during school-travel hours decreased 44% (95% CI: 17 to 65) from 8.0 injuries per 10 000 population in the preintervention period (2001-2008) to 4.4 injuries per 10 000 population in the postintervention period (2009-2010) in census tracts with SRTS interventions. The rate remained virtually unchanged in census tracts without SRTS interventions (0% [95% CI: -8 to 8]).
Conclusions:
Implementation of the SRTS program in New York City has contributed to a marked reduction in pedestrian injury in school-aged children.
Pedestrian injury is among the leading causes of pediatric death in the United States and much of the world. This paper is divided into two sections. First, we review the literature on behavioral risk factors for child injury. Cognitive and perceptual development risks are discussed. The roles of distraction, temperament and personality, and social influences from parents and peers are presented. We conclude the first section with brief reviews of environmental risks, pedestrian safety among special populations, and the role of sleep and fatigue on pediatric pedestrian safety. The second section of the review considers child pedestrian injury prevention strategies. Categorized by mode of presentation, we discuss parent instruction strategies, school-based instruction strategies (including crossing guards), and streetside training techniques. Technology-based training strategies using video, internet, and virtual reality are reviewed. We conclude the section on prevention with discussion of community-based interventions.
Active transportation to school provides a means for youth to incorporate physical activity into their daily routines, and this has obvious benefits for child health. Studies of active transportation have rarely focused on the negative health effects in terms of injury. This cross-sectional study is based on the 2009/10 Canadian Health Behaviour in School-Aged Children survey. A sample of children aged 11-15 years (n=20 076) was studied. Multi-level logistic regression was used to examine associations between walking or bicycling to school and related injury. Regular active transportation to school at larger distances (approximately >1.6 km; 1.0 miles) was associated with higher relative odds of active transportation injury (OR: 1.52; 95% CI 1.08 to 2.15), with a suggestion of a dose-response relationship between longer travel distances and injury (p=0.02). Physical activity interventions for youth should encourage participation in active transportation to school, while also recognising the potential for unintentional injury.
The study examined pedestrians’ self-reported road-crossing behavior in relation to beliefs regarding the consequences of the behavior incorporated in the health belief model, instrumental and normative motives for compliance with safety rules, and situational factors. A questionnaire was administered to 205 students at two Israeli higher education institutions. The results show that crossing against a `Don’t walk' sign is predicted by perceived consequences of the behavior, as well as by normative motives. The results revealed consistent gender differences: women’s perception of their susceptibility to an accident resulting from an unsafe crossing is higher than that of men; women also report more than men that they are motivated by normative and instrumental considerations. Nevertheless, for women unsafe crossing is predicted only by instrumental motives, whereas for men both normative and instrumental motives predict unsafe crossing behavior. Among the situational variables, the presence of other pedestrians is related to the self-reported crossing behavior of women, whereas traffic volume is related to that of men. The results are discussed with regard to similarities and differences between pedestrians and drivers in compliance with safety laws.
This study investigates the relationships between the built environment, the physical attributes of the neighborhood, and the residents' perceptions of those attributes. It focuses on destination walking and self-reported health, and does so at the neighborhood scale. The built environment, in particular sidewalks, road connectivity, and proximity of local destinations, correlates with destination walking, and similarly destination walking correlates with physical health. It was found, however, that the built environment and health metrics may not be simply, directly correlated but rather may be correlated through a series of feedback loops that may regulate risk in different ways in different contexts. In particular, evidence for a feedback loop between physical health and destination walking is observed, as well as separate feedback loops between destination walking and objective metrics of the built environment, and destination walking and perception of the built environment. These feedback loops affect the ability to observe how the built environment correlates with residents' physical health. Previous studies have investigated pieces of these associations, but are potentially missing the more complex relationships present. This study proposes a conceptual model describing complex feedback relationships between destination walking and public health, with the built environment expected to increase or decrease the strength of the feedback loop. Evidence supporting these feedback relationships is presented.
The purpose of this study is to assess the reliability and validity of the U.S. National Center for Safe Routes to School's in-class student travel tallies and written parent surveys. Over 65,000 tallies and 374,000 parent surveys have been completed, but no published studies have examined their measurement properties.
Students and parents from two Charlotte, NC (USA) elementary schools participated. Tallies were conducted on two consecutive days using a hand-raising protocol; on day two students were also asked to recall the previous days' travel. The recall from day two was compared with day one to assess 24-hour test-retest reliability. Convergent validity was assessed by comparing parent-reports of students' travel mode with student-reports of travel mode. Two-week test-retest reliability of the parent survey was assessed by comparing within-parent responses. Reliability and validity were assessed using kappa statistics.
A total of 542 students participated in the in-class student travel tally reliability assessment and 262 parent-student dyads participated in the validity assessment. Reliability was high for travel to and from school (kappa > 0.8); convergent validity was lower but still high (kappa > 0.75). There were no differences by student grade level. Two-week test-retest reliability of the parent survey (n=112) ranged from moderate to very high for objective questions on travel mode and travel times (kappa range: 0.62-0.97) but was substantially lower for subjective assessments of barriers to walking to school (kappa range: 0.31-0.76).
The student in-class student travel tally exhibited high reliability and validity at all elementary grades. The parent survey had high reliability on questions related to student travel mode, but lower reliability for attitudinal questions identifying barriers to walking to school. Parent survey design should be improved so that responses clearly indicate issues that influence parental decision making in regards to their children's mode of travel to school.
The paper reviews the scientific literature concerning social differences in traffic injuries in childhood in order to highlight the current state of knowledge and to draw the main lines of a research agenda.
A conceptual framework is used that identifies the mechanisms through which social context, social position, and various exposures may interact in the determination of health inequalities. It is used as a frame for presenting the evidence accumulated so far concerning social differences in traffic injury in childhood, including pedestrian, cyclist, and vehicle passenger injuries.
For most types of traffic injuries, mortality and morbidity are often higher among children from lower social positions and in more deprived socioeconomic areas. Whether the greater occurrence of injuries in deprived areas is a phenomenon attributable to the areas themselves, or merely a reflection of a wider pattern of injuries affecting lower socioeconomic groups, is unclear. There is evidence of an interaction effect between age and gender, and also between socioeconomic status and gender.
The mechanisms leading to social inequalities in traffic injuries in childhood deserve greater scrutiny in future research. Further theoretical developments and empirical investigation will help define intervention needs and enable more effective targeted, long term prevention.
We sought to determine the association between urban sprawl and traffic fatalities.
We created a sprawl index by applying principal components analysis to data for 448 US counties in the largest 101 metropolitan areas. Regression analysis was used to determine associations between the index and traffic fatalities.
For every 1% increase in the index (i.e., more compact, less sprawl), all-mode traffic fatality rates fell by 1.49% (P <.001) and pedestrian fatality rates fell by 1.47% to 3.56%, after adjustment for pedestrian exposure (P <.001).
Urban sprawl was directly related to traffic fatalities and pedestrian fatalities. Subsequent studies should investigate relationships at a finer geographic scale and should strive to improve on the measure of exposure used to adjust pedestrian fatality rates.
To examine the relationship between the numbers of people walking or bicycling and the frequency of collisions between motorists and walkers or bicyclists. The common wisdom holds that the number of collisions varies directly with the amount of walking and bicycling. However, three published analyses of collision rates at specific intersections found a non-linear relationship, such that collisions rates declined with increases in the numbers of people walking or bicycling.
This paper uses five additional data sets (three population level and two time series) to compare the amount of walking or bicycling and the injuries incurring in collisions with motor vehicles.
The likelihood that a given person walking or bicycling will be struck by a motorist varies inversely with the amount of walking or bicycling. This pattern is consistent across communities of varying size, from specific intersections to cities and countries, and across time periods.
This result is unexpected. Since it is unlikely that the people walking and bicycling become more cautious if their numbers are larger, it indicates that the behavior of motorists controls the likelihood of collisions with people walking and bicycling. It appears that motorists adjust their behavior in the presence of people walking and bicycling. There is an urgent need for further exploration of the human factors controlling motorist behavior in the presence of people walking and bicycling.
A motorist is less likely to collide with a person walking and bicycling if more people walk or bicycle. Policies that increase the numbers of people walking and bicycling appear to be an effective route to improving the safety of people walking and bicycling.
Overseas research shows that fatality and injury risks per cyclist and pedestrian are lower when there are more cyclists and pedestrians. Do Australian data follow the same exponential 'growth rule' where (Injuries)/(Amount of cycling) is proportional to ((Amount of cycling)-0.6)?
Fatality and injury risks were compared using three datasets: 1) fatalities and amounts of cycling in Australian States in the 1980s; 2) fatality and injury rates over time in Western Australia as cycling levels increased; and 3) deaths, serious head injuries and other serious injuries to cyclists and pedestrians in Victoria, before and after the fall in cycling with the helmet law.
In Australia, the risks of fatality and injury per cyclist are lower when cycling is more prevalent. Cycling was safest and most popular in the Australian Capital Territory (ACT), Queensland and Western Australia (WA). New South Wales residents cycled only 47% as much as residents of Queensland and WA, but had 53% more fatalities per kilometre, consistent with the growth rule prediction of 52% more for half as much cycling. Cycling also became safer in WA as more people cycled. Hospitalisation rates per 10,000 regular cyclists fell from 29 to 15, and reported deaths and serious injuries from 5.6 to 3.8 as numbers of regular cyclists increased. In Victoria, after the introduction of compulsory helmets, there was a 30% reduction in cycling and it was associated with a higher risk of death or serious injury per cyclist, outweighing any benefits of increased helmet wearing.
As with overseas data, the exponential growth rule fits Australian data well. If cycling doubles, the risk per kilometre falls by about 34%; conversely, if cycling halves, the risk per kilometre will be about 52% higher. Policies that adversely influence the amount of cycling (for example, compulsory helmet legislation) should be reviewed.
Active transportation to and from school (ATS) is a viable strategy to help increase physical activity among youth. ATS can be challenging because initiatives require transdisciplinary collaboration, are influenced by the built environment and are affected by numerous policies. The purpose of this study is to identify policies and factors that influence ATS initiatives. Nine elementary schools in seven states participated in this case study. Sixty-nine stakeholders were interviewed. The interviews were transcribed, coded and analyzed using a master thematic codebook. This study identified two distinct aspects of policies: 'influential factors' which are factors that might impact policies related to ATS and 'policy actions' which are policies reported by people involved in ATS initiatives that directly affected their success. Influential factors included sidewalks, crosswalks/crossing guards, funding, personal safety concerns, advocacy group involvement and others. Policy actions included policies on school speed zone, drop-off, no-transport zones, school siting, school start/dismissal time and school choice. Despite the diversity of the schools studied, similarities included influence of built environment, safety concerns, funding and transdisciplinary collaboration. Stakeholders need to work together to stimulate action and ensure successful initiatives. Influential factors appear to be important to this process.
Policymakers in many countries, including the United States, United Kingdom, and Australia, have introduced programs to increase walking and biking to school through education, encouragement, and infrastructure improvements. The U.S. government has allocated over $1.1 billion to the federal Safe Routes to School program since 2005. However, there are few evaluations of the Safe Routes to School program. Our study used a robust quasi-experimental research design to measure the impacts of Eugene, Oregon's Safe Routes to School program on walking and biking. Using data collected between 2007 and 2011 at 14 schools with and without Safe Routes to School programs, we showed that the Safe Routes to School program was associated with increases in walking and biking. Education and encouragement programs were associated with a five percentage point increase in biking. Augmenting education programs with additional SRTS improvements such as sidewalks, crosswalks, covered bike parking, and Boltage was associated with increases in walking and biking of 5-20 percentage points. The study results illustrate the potential for the Safe Routes to School program to change behavior and should encourage other communities to plan for multi-modal school travel.
In September 2003, 10 years ago, the American Journal of Public Health published its special issue on "Built Environment and Health." That issue marked a renaissance of interest in this topic. Almost simultaneously, the American Journal of Health Promotion released a special issue on "Health Promoting Community Design," and three years later, the Journal of the American Planning Association released a special issue on "Planning's Role in Building Healthy Cities." The health professions and the design professions had reengaged. (Am J Public Health. Published online ahead of print July 18, 2013: e1-e3. doi:10.2105/AJPH.2013.301482).
This research explores the spatial distribution of pedestrian-automobile collisions in Los Angeles and analyzes the social and physical factors that affect the risk of getting involved in such collisions. More specifically, this study investigates the influence of socio-demographic, land use, density, urban form, and traffic characteristics on pedestrian collision rates. We first provide an exploratory spatial and statistical analysis of pedestrian collision data in the city of Los Angeles to identify preliminary relationships between the frequency of collisions and socio-demographic and land use characteristics at the census tract level. This aggregate level analysis points to major concentrations of pedestrian collision data which are used at a second stage of the research for more qualitative and detailed analysis of specific case studies of intersections with high frequency of pedestrian collisions.
The article reaches two conclusions counter to accepted transportation engineering theory. First, the traffic environments of dense urban areas appear to be safer than the lower-volume environments of the suburbs. The reason is that many fewer miles are driven on a per capita basis, and the driving that is done is at lower speeds that are less likely to produce fatal crashes. Second, at least in dense urban areas, less-“forgiving” design treatments—such as narrow lanes, traffic-calming measures, and street trees close to the roadway—appear to enhance a roadway's safety performance when compared to more conventional roadway designs. The reason for this apparent anomaly may be that less-forgiving designs provide drivers with clear information on safe and appropriate operating speeds.
This article examines health promotion and disease prevention from the perspective of social cognitive theory. The areas of overlap with some of the most widely applied psychosocial models of health are identified. The models of health promotion and disease prevention have undergone several generational changes. We have shifted from trying to scare people into health, to rewarding them into health, to equipping them with self-regulatory skills to manage their health habits, to shoring up their habit changes with dependable social supports. These transformations have evolved a multifaceted approach that addresses the reciprocal interplay between self-regulatory and environmental determinants of health behavior. Social cognitive theory addresses the socio structural determinants of health as well as the personal determinants. A comprehensive approach to health promotion requires changing the practices of social systems that have widespread detrimental effects on health rather than solely changing the habits of individuals. Further progress in this field requires building new structures for health promotion, new systems for risk reduction and greater emphasis on health policy initiatives. People's beliefs in their collective efficacy to accomplish social change, therefore, play a key role in the policy and public health approach to health promotion and disease prevention.
We examined the extent to which differential traffic volume and road geometry can explain social inequalities in pedestrian, cyclist, and motor vehicle occupant injuries across wealthy and poor urban areas.
We performed a multilevel observational study of all road users injured over 5 years (n=19,568) at intersections (n=17,498) in a large urban area (Island of Montreal, Canada). We considered intersection-level (traffic estimates, major roads, number of legs) and area-level (population density, commuting travel modes, household income) characteristics in multilevel Poisson regressions that nested intersections in 506 census tracts.
There were significantly more injured pedestrians, cyclists, and motor vehicle occupants at intersections in the poorest than in the richest areas. Controlling for traffic volume, intersection geometry, and pedestrian and cyclist volumes greatly attenuated the event rate ratios between intersections in the poorest and richest areas for injured pedestrians (-70%), cyclists (-44%), and motor vehicle occupants (-44%).
Roadway environment can explain a substantial portion of the excess rate of road traffic injuries in the poorest urban areas.
As automobile transportation continues to increase around the world, bicyclists, pedestrians, and motorcyclists, also known as vulnerable road users (VRUs), will become more susceptible to traffic crashes, especially in countries where traffic laws are poorly enforced. Many countries, however, are employing innovative strategies to ensure that road users can more safely navigate the urban landscape. While bicyclists and motorcyclists are important road users, this paper will focus on pedestrian crash problems and solutions. Pedestrians are most at risk in urban areas due in part to the large amount of pedestrian and vehicle activity in urban areas. With this in mind, designing safe, accessible, and comprehensive facilities for pedestrians is vital to reducing pedestrian crashes. This paper will provide some insight into the magnitude of the pedestrian crash problem around the world, and will offer some lessons learned from several countries, particularly in Europe and the U.S., for improving pedestrian safety. Beginning with pedestrian safety statistics at the global, regional, and national levels, this paper will address potential countermeasures and strategies for improving pedestrian safety from an international perspective.
In this paper, we present an analysis of the relationship between pedestrian-vehicle crashes and characteristics of areas with high low-income and minority populations in the Chicago metropolitan area (also called environmental justice or EJ areas in the United States). While related research has indicated that pedestrian crashes occur more frequently in these areas than in non-EJ areas, this paper attempts to relate the incidence to environmental characteristics and behavioral factors through a better understanding of the contributing factors present in crash occurrences in EJ versus non-EJ areas. Specially constructed small-area factors from a Spatial Decision Support System (SDSS) are used to explain pedestrian-vehicle crashes. Using a Poisson model that corrects for underreporting, we find that pedestrian crash incidents in EJ areas are related to variables of exposure (including the suitability of the area for walking and transit accessibility), crime rates, transit availability, and general population demographics such as income and presence of children. Results suggest that it may be necessary to better incorporate a safety perspective or measures of safety improvements in pedestrian and transit improvements and expansion programs within EJ areas.
The built environment can be considered a foundation for health and wellness. This structure, whether it be neighborhood layout or safe walking trails, impacts decisions relating to individual and community health outcomes. This review compiled the published research that examined the relationship between built environment and health. Findings from the 23 articles reviewed indicate that neighborhoods that are characterized as more walkable, either leisure-oriented or destination-driven, are associated with increased physical activity, increased social capital, lower overweight, lower reports of depression, and less reported alcohol abuse.
Miami-Dade County, FL, has one of the highest numbers of pediatric pedestrian injuries in the country. To respond to this problem, WalkSafe an elementary school-based pedestrian injury prevention program was created. The purpose of this study was to evaluate the effectiveness of the 3-day WalkSafe educational curriculum in a high-risk district.
Sixteen elementary schools were identified and enrolled in the study. Children (n = 10,621) in grades K-5 participated in the WalkSafe program in October 2006. Four of the 16 schools were randomly selected to receive pre-, post-, and 3-month posteducational testing of pedestrian safety knowledge. Teachers (n = 462) were asked to complete teacher surveys to gain feedback about the program.
A total of 2,987 tests were collected during the three different testing times. Grades were combined to form groups (K-1), (2-3), and (4-5). Significant differences were observed (p value <0.05) between pre- and posttesting for grades K-1 and 2-3. No significant differences were found between pre- and posttesting for (4-5) and between post- and 3-month testing across all grades (p value >0.05). There were 154 (30%) of the teacher surveys returned.
The 3-day WalkSafe educational curriculum implemented in a high-risk district was shown to increase the pedestrian safety knowledge of elementary school age children. From recommendations made by teachers and multiple agencies, the modified 3-day program was approved to implement on a yearly basis in all public elementary schools in Miami-Dade County. Further studies will investigate the transfer of knowledge gain to behavioral change among elementary school-aged children.
The study compares young and older drivers' motives for compliance with traffic laws. Instrumental motives, such as perceived danger of violations, and normative motives, such as a sense of obligation to obey the law, were explored. A questionnaire was administered to 693 male drivers in the Israeli army. The results support previous findings, showing that young drivers' motives for compliance with traffic laws, both instrumental and normative, are weaker than those of older drivers. The differences between the two age groups are larger with regard to normative than to instrumental motives. The commission of traffic violations by young drivers is predicted by the normative motives of a sense of obligation to obey traffic laws and perceived fairness of punishment. The commission of driving violation by older drivers is predicted by the instrumental motive of perceived danger of violations. The differences between young and older drivers' motives are discussed.
A unique database provided information on pedestrian accidents, intersection geometry and estimates of pedestrian and vehicle flows for the years 1983-1986 for approximately 300 signalized intersections in Hamilton, Ont., Canada. Pedestrian safety at semi-protected schemes, where left-turning vehicles face no opposing traffic but have potential conflicts with pedestrians, were compared with pedestrian safety at normal non-channelized signalized approaches, where right-turning vehicles have potential conflicts with pedestrians. Four different ways of estimating hourly flows for left- and right-turning vehicles were explored. Hourly flows were estimated for periods of 15 min, hours, two periods a day (a.m. and p.m.) and the 'daily' period (7 h). Parameter estimates were somewhat affected by the time period used for flow estimation. However, parameter estimates seem to be affected far more by the traffic pattern (left- or right-turning traffic), even though approaches were selected such that the situation for left- and right-turning turning traffic was similar (no opposing traffic, no advanced green or other separate phases and no channelization). Left-turning vehicles caused higher risks for pedestrians than right-turning vehicles. At low vehicular flows right turns and semi-protected left turns seemed to be equally safe for pedestrians. When risks for pedestrians were calculated as the expected number of reported pedestrian accidents per pedestrian, risk decreased with increasing pedestrian flows and increased with increasing vehicle flow. As risk decreases with increasing pedestrian flows, promoting walking will have a positive effect on pedestrian risk at signalized intersections.
To evaluate the effectiveness of the WalkSafe program, an elementary school-based pedestrian safety program in a single high-risk district in Miami-Dade County.
Sixteen elementary schools were identified in a single high-risk district and enrolled in a one-year study. All schools implemented the WalkSafe program on the last week of January 2003. A pre, post, and three-month post testing of pedestrian safety knowledge was conducted. An observational component was also implemented at four schools that were randomly chosen. Engineering recommendations and law enforcement initiatives were also performed.
A total of 6467 children from K-5th grade from 16 elementary schools participated in the program. Of these 5762 tests were collected over three different testing times. A significant difference (p-value < 0.001) was found between the pre and post testing conditions across all grade levels. There was no significant difference found between the post and three-month post testing conditions across all grade levels (p-value > 0.05). The observational data collected at four schools across the different testing times demonstrated a significant difference found between pre and post testing conditions for Group A (stop at the curb and look left, right, left) and also for Group B (midstreet crossing and darting out) (p-value < 0.05). There was no difference found between comparing the pre-test or post-test condition with the three-month post-test time. There were many environmental modifications that were recommended and actually performed.
The WalkSafe program implemented in a single high-risk district was shown to improve the pedestrian safety knowledge of elementary school children. The observational data demonstrated improved crossing behaviors from pre-test to post-testing conditions. Future research will focus on sustaining the program in this district and expanding the program throughout our county.
Compared with previous generations, children spend less time playing outdoors and have lower participation rates in active transport. Many studies have identified lack of neighbourhood safety as a potential barrier to children's physical activity. This review describes concerns regarding 'stranger danger' and road safety, and discusses empirical studies that examine associations between neighbourhood safety and physical activity among youth. Variability of perceptions of safety between parents and youth are examined; 'social traps' are identified; and physical/social environmental interventions aimed at improving neighbourhood safety are discussed. A research agenda is suggested for further study of perceived and objective measures of neighbourhood safety and their associations with children's physical activity.
Dangerous by design: solving the epidemic of preventable pedestrian deaths
- M. Ernst
- M. Lang
- S. Davis
- M. Ernst
- M. Lang
- S. Davis
Promoting Active Transportation: An Opportunity for Public Health
- Safe Routes to School National Partnership American Public Health Association
- Safe Routes to School National Partnership American Public Health Association
Measuring Unsafe Pedestrian Behavior Using Observational Data
- Kourtellis
- Kourtellis
Dangerous by design: solving the epidemic of preventable pedestrian deaths
- M Ernst
- M Lang
- S Davis
- R Ewing
- E Dumbaugh
Ernst, M., Lang, M., Davis, S., 2011. Dangerous by design: solving the epidemic of preventable pedestrian deaths. Transportation for America, Washington, DC
Ewing, R., Dumbaugh, E., 2009. The Built Environment and Traffic Safety A Review of Empirical Evidence. J. Plann. Lit. 23 (4), 347-367.
Active Transportation: Making the Link from Transportation to Physical Activity and Obesity. A Research Brief
- D Rodriguez
Rodriguez, D., 2009. Active Transportation: Making the Link from Transportation to Physical Activity and Obesity. A Research Brief. Princeton, NJ: Active Living Research, a
National Program of the Robert Wood Johnson Foundation. Available from: 〈www.activelivingresearch.org〉.
State and County QuickFacts: City of Miami, Florida Retrieved
- U S Bureau
U.S. Census Bureau (2010) State and County QuickFacts: City of Miami, Florida Retrieved October 30, 2013 from: 〈http://quickfacts.census.gov/qfd/states/12/1245000.html〉.