Practitioners implementing Safe Routes to School programs, or other active travel promotion programs, have a large scope of issues to address.
This section is a collection of research that evaluates current Safe Routes to School programs and identifies issues to consider when implementing new programs. Findings from these studies can provide insight into the cost-effectiveness of programs, impact of school siting, and how gender and socio-demographic factors can influence active travel to school.
Also included in this section is academic literature reviewing legislative policies that can provide practitioners with information regarding potential funding opportunities and policy trends that influence active transport initiatives. Many of the articles in this section directly reference Safe Routes to School programs.
- Safe Routes to School programs have shown a 37 percent increase in bicycling and walking where projects have been undertaken. (Stewart, 2014)
- Specific to Safe Routes to School, introducing a program focused on education and encouragement increased bicycling to school by 5 percent each year. When programs also incorporated infrastructure improvements like sidewalks, crosswalks and covered bicycle parking, the rate of bicycling and walking improved to between 5 percent and 20 percent (McDonald, 2013).
- One study reports that the national Safe Routes to School program has the potential to positively influence individuals, communities, and the environment regardless of race, ethnicity, or socioeconomic status by providing funds to address some of the barriers and improve the ability of students to safely walk and bicycle to school (Martin, et al., 2008).
- The findings of an analysis of walking and biking to school among low-income and minority youth in the United States has significant implications, reporting that Safe Routes to School programs have the potential to strongly benefit minority and low-income students, especially because many of those students are more likely to live near the school they attend (McDonald, 2008).
- The odds of walking and bicycling to school are 40% lower in girls than in boys (McMillan, et al., 2006).
- Results show that children who pass completed Safe Routes to School projects are more likely to show increases in walking or bicycle travel than are children who do not pass by projects (15% vs. 4%), supporting the effectiveness of Safe Routes to School construction projects (Boarnet, et al., 2005).
- A review of the success of the Safe Routes to School program in Marin County reports a 64% increase in the number of children walking to school, a 114% increase in the number of students biking, and a 91% increase in the number of students carpooling (Staunton, et al., 2003).
Academic Research Articles and Findings:
- Biking and walking to school may vary by factors like distance to school, speed of traffic, school encouragement, and children asking permission.
- Students were 2.6 times as likely to walk or bike to school if these modes were promoted by the school.
- Students who lived within 0.5 miles of the school were 16.7 times as likely to walk or bike to school than those living further away.
- Lower travel times were associated with higher percentages of walking and biking to school; 23.8% of children biked or walked who were less than 5 minutes away, while only 2.2% of children more than 20 minutes utilized active modes.
- More children in kindergarten through fifth grade walked or biked to school than children in sixth through eighth grade.
- Students who asked permission from their parents to walk or bike to school in the past year were seven times as likely to be using active transportation modes.
- Children whose parents reported recognizing most people on the block were 1.6 times as likely to walk or bike to school compared to children whose parents did not recognize most people.
- · Children of parents who reported speed of traffic as a significant factor affecting their decision to allow children to walk/bike to school were 58% less likely to walk/bike to school than parents who did not identify speed as a significant factor.
- This study conducted a baseline assessment of 5 SRTS-awarded schools from pre-kindergarten to eighth grade in communities with similar median incomes in Louisiana. Data was collected using parent surveys, teacher tallies, and the Pedestrian Environmental Data Scan (PEDS).
Gustat, J., Richards, K., Rice, J., Andersen, L., Parker-Karst, K., Cole, S. (2015). Youth Walking and Biking Rates Vary by Environments Around 5 Louisiana Schools. Journal of School Health, 85 (1), 36-42.
- National governments have provided subsidies for investments in increasing the safety and attractiveness of walking and biking to school. Evaluations of Safe Routes to School initiatives have found that they have been effective at changing behavior and reducing injuries.
- However, there has been little attention to the impacts of these programs on pupil transportation costs.
- This analysis assesses the potential economic benefits of Safe Routes to School programs in the US context by estimating the annual costs of using motorized transport for short trips to schools, examining real-world examples of the costs savings of SRTS programs, and evaluating land use impacts on school transportation costs using a simulation analysis of school bus routes.
- We find that there is potential for school districts and families to reduce transport expenditures through public sector investments in walking and biking infrastructure near schools. We also find that land use context matters and the most cost-effective investments would benefit schools where large numbers of children live within walking distance.
McDonald NC, Steiner RL, Palmer WM, Bullock AN, Sisiopiku VP, and Lytle BF. Costs of school transportation: quantifying the fiscal impacts of encouraging walking and bicycling for school travel. Transportation 2014, November.
- Objective. Joint use policies (JUP) encourage shared facility use, usually between schools and a city or private organization, for both physical activity-related and non-physical activity-related programs. Little is known about JUP's impact on physical activity (PA). This study examined whether more specific JUPs were associated with increased PA and decreased sedentary behavior (SB) in adolescents.
- Methods. Data on PA, sports participation, and SB were taken from annual cross-sectional nationally representative samples of 51,269 8th, 10th and 12th grade public school students nested in 461 school districts in the US from 2009–2011. JUP measures were constructed using information obtained from corresponding school district JU policies. Multivariable analyses were conducted, controlling for individual demographic and socioeconomic characteristics and clustering at the district level.
- Results. Results showed small associations between more specific JUPs and increased PA (IRR 1.01, 95% CI: 1.00, 1.02). Closer examination of specific JUP provisions indicates that specifying what times facilities are available for use was associated with vigorous exercise and prioritizing school or affiliated organizations' use and which spaces were available for use were associated with vigorous exercise and more frequent PA participation, which includes participation in sports or athletics. No associations were found between more specific JUPs and SB.
- Conclusions. JUPS may have small influences on adolescent physical activity behavior. Future longitudinal studies should be conducted to examine the impact of JUPs in conjunction with other physical activity-related policies and environmental changes to determine what impact they have on overall adolescent physical activity and sedentary behavior.
Slater S, Chriqui J, Chaloupka FJ, Johnston L. Joint use policies: Are they related to adolescent behavior? Prev. Med 2014 Dec; 69S:S37-S43.
- Defining healthy schools remains largely discipline specific. Design disciplines ground discussions in a “green building” framework. Public health approaches healthy schools through programmatic interventions for physical activity and nutrition.
- This article presents a more systemic approach to healthy schools via health impact assessment (HIA). It reviews literature on health determinants in school environments, focusing on physical design. Existing school HIAs are reviewed with other decision support tools that provide guidance on the operation and design of healthy schools.
- The paper examines current use of HIAs in schools and develops a screening matrix for using HIA in creating healthy schools.
Arthi Rao, Catherine L. Ross. Health Impact Assessments and Healthy Schools. Journal of Planning Education and Research 2014;34(2):141-152.
- Despite the growing interest in expanding the joint use of K–12 public schools by public health and planning practitioners to promote healthy, sustainable communities, the topic has received little attention in the urban planning and public health scholarship.
- The objective of this article is to situate joint use in the academic literature focused on the links between built environments and health.
- The author examines the “state of the field” of K–12 joint use through studying the academic and associated literature, interviews, participant observation, and case examples and develops a joint use classification system to aid researchers and practitioners.
Vincent J. Joint Use of Public Schools: A Framework for Promoting Healthy Communities. Journal of Planning Education and Research 2014;34(2):153-168.
- In 2005, the United States Congress directed the Federal Highway Administration (FHWA) to develop the Nonmotorized Transportation Pilot Program (NTPP).
- The program provided over $25 million in contract authority to four pilot communities (Columbia, Missouri; Marin County, California; Minneapolis area, Minnesota; and Sheboygan County, Wisconsin) for pedestrian and bicycle infrastructure and nonmotorized programs.
- This report summarizes the progress and results of the NTPP from August 2005 through December 2013, updating and expanding upon the analysis from the Report to the U.S. Congress on the Outcomes of the Nonmotorized Transportation Pilot Program, submitted by the Federal Highway Administration in April 2012.
- This report analyzes the results through December 2013 of the NTPP in terms of program implementation, transportation mode shift toward walking and bicycling and associated improvements pertaining to access and mobility, safety and public health, and the environment and energy.
- From 2007 to 2013, the pilot communities observed an estimated 22.8 percent increase in the number of walking trips and an estimated 48.3 percent increase in the number of bicycling trips.
- This report examines how the NTPP pilot communities provide examples to other communities interested in implementing and evaluating nonmotorized investments.
William Lyons, Benjamin Rasmussen, David Daddio, Jared Fijalkowski, Erica Simmons. (2014). Nonmotorized Transportation Pilot Program: Continued Progress in Developing Walking and Bicycling Networks – May 2014 Report In U. S. D. o. Transportation, J. A. V. N. T. S. Center & T. P. Division (Eds.). 55 Broadway Cambridge, MA 02142-1093: US Dept of Transportation.
- Purpose and Method: This research brief examines elementary school administrators’ reports of school participation in Safe Routes to School initiatives and estimated rates of active travel by students, as collected by surveys from administrators at nationally-representative samples of U.S. public elementary schools between the 2006-07 and 2012-13 school years.
- Results: The prevalence of elementary school participation in SRTS programs grew steadily over the past seven years, increasing by 54 percent between 2006-07 and 2012-13 (from14.2% of schools to 21.8% of schools). Rates of student active travel to school, as estimated by school administrators, were 60 percent higher at schools that participated in SRTS programs (where 32.4% of students walked or biked) than at schools that did not participate (where 20.2% of students walked or biked). In examining the 2012-13 survey, SRTS programming did not differ by the school’s socioeconomic characteristics.
- Conclusions: Active travel is a promising strategy for keeping children physically active and for reducing the adverse health consequences of inactivity, such as childhood obesity. SRTS programs are associated with higher reported rates of children walking or biking to school.
Turner L, Slater S, Chaloupka FJ. . (2014). Elementary School Participation in Safe Routes to School Programming is Associated with Higher Rates of Student Active Travel to School. In H. P. C. Bridging the Gap Program, Institute for Health Research and Policy (Ed.), A BTG Research Brief. Chicago, IL.: University of Illinois at Chicago.
- Purpose: State Safe Routes to School (SRTS) programs provide competitive grants to local projects that support safe walking, bicycling, and other modes of active school travel (AST). This study assessed changes in rates of AST after implementation of SRTS projects at multiple sites across four states (Florida, Mississippi, Washington and Wisconsin).
- Measures: AST was measured as the percentage of students walking, bicycling, or using any AST mode. SRTS project characteristics were measured at the project, school, and school neighborhood levels in 53 schools affected by 48 completed Safe Routes to School projects.
- Results: Statistically significant increases in AST were observed across projects in all four states. All AST modes increased from 12.9% to 17.6%; walking from 9.8% to 14.2%; and bicycling from 2.5% to 3.0%. Increases in rates of bicycling were negatively correlated with baseline rates of bicycling.
- Conclusion: State-funded SRTS projects are achieving one of the primary program goals of increasing rates of AST. They may be particularly effective at introducing bicycling to communities where it is rare. The evaluation framework introduced in this study can be used to continue tracking the effect of state SRTS programs as more projects are completed.
Orion Stewart, Anne Vernez Moudon, and Charlotte Claybrooke (2014). Multistate Evaluation of Safe Routes to School Programs. American Journal of Health Promotion, 28(sp3), S89-S96.
- Objective. We evaluated the cost-effectiveness of a package of roadway modifications in New York City funded under the Safe Routes to School (SRTS) program.
- Methods. We used a Markov model to estimate long-term impacts of SRTS on injury reduction and the associated savings in medical costs, lifelong disability, and death. Model inputs included societal costs (in 2013 US dollars) and observed spatiotemporal changes in injury rates associated with New York City's implementation of SRTS relative to control intersections. Structural changes to roadways were assumed to last 50 years before further investment is required. Therefore, costs were discounted over 50 consecutive cohorts of modified roadway users under SRTS.
- Results. SRTS was associated with an overall net societal benefit of $230 million and 2055 quality-adjusted life years gained in New York City.
- Conclusions. SRTS reduces injuries and saves money over the long run.
Muennig, P. A., Epstein, M., Li, G., & DiMaggio, C. (2014). The Cost-Effectiveness of New York City's Safe Routes to School Program. Am J Public Health. doi: 10.2105/ajph.2014.301868
- Despite the health benefits associated with physical activity participation, activity levels of North American children are declining. In response, practitioners are placing emphasis on active forms of transportation to and from school. The purpose of this study was to explore the barriers and facilitators to active transportation to school (ATS) from the perspectives of practitioners.
- The perspectives of 19 practitioners (eg, health promoters, traffic engineers, police, etc.) from 3 communities in Alberta, Canada were captured using focus group interviews followed by content analysis.
- Subthemes tied to barriers included logistics, lifestyle, safety, and lack of resources; while facilitators were comprised of collaboration, education, and leadership. The results were interpreted using an ecological model of health behavior.
- The most common ATS barriers: attitudes and safety concerns, lack of resources and time, and the nature of the natural and built environments were associated with the intrapersonal, organizational, and physical environmental factors, respectively. The most significant organizational facilitators concerned collaboration among parents, schools, businesses, community organizations, and government agencies. While the multifaceted nature of barriers and facilitators add complexity to the issue, it also challenges practitioners to think and act creatively in finding solutions.
Loitz CC, Spencer-Cavaliere N. (2013). Exploring the Barriers and Facilitators to Children's Active Transportation to and From School From the Perspectives of Practitioners. J Phys Act Health, 10(8), 1128-1135.
- In many developed countries walking and bicycling are not extensively used as a means of transportation. Further, the share of these non-motorized travel modes (as a percentage of all trips) has been reducing over time.
- The increasingly low use of walk and bicycle modes of transportation, and the concomitant increasing use of motorized vehicles for transportation, may be associated with several factors, including land use and development patterns, traffic safety and personal security concerns, and perceptions of and attitudes towards non-motorized transport. These factors manifest themselves differently in developing and developed countries, but throughout the world the increasing reliance on motorized transport contributes to serious traffic congestion problems, air quality degradation, and greenhouse gas emission increases.
- In addition to transportation professionals, health agencies are also paying increased attention to non-motorized modes, or “active transport” as a route to improve public health.
- In this chapter, the authors discuss the many benefits of non-motorized travel, identify its facilitators and impediments, analyze its utilization in select developed and developing countries, review previous studies of the effectiveness of strategies to promote it, and recommend possible pathways to promote non-motorized travel as a sustainable travel option.
Christina Bernardo, Chandra Bhat. (2014). Non-motorized Travel as a Sustainable Travel Option Handbook of Sustainable Travel (pp. 277-291). Netherlands: Springer Netherlands.
- This study assesses how federal Safe Routes to School (SRTS) funds were allocated to public and private schools and communities and whether there were demographic or locational differences between schools that benefited from SRTS funding and those that did not receive SRTS awards.
- The study analyzes all SRTS projects awarded between 2005 and 2012 (N1⁄45532) by using descriptive statistics to profile SRTS funding amounts and purposes, and to compare demographic and neighborhood characteristics of schools with and without SRTS programs. Analysis was conducted in 2013.
- The average SRTS award was $158,930 and most funding was spent on infrastructure (62.8%) or combined infrastructure and non-infrastructure (23.5%) projects.
- Schools benefiting from the SRTS program served higher proportions of Latino students and were more likely to be in higher-density areas. Few differences existed in neighborhood demographics, particularly educational attainment, work-trip commute mode, and median household income.
- Conclusions: Schools benefiting from the SRTS program are more urban and have higher Latino populations but are otherwise comparable to U.S. public schools. This suggests that disadvantaged areas have had access to the SRTS program.
Noreen C. McDonald, PhD, Pamela H. Barth, MRP, Ruth L. Steiner, PhD. (2013). Assessing the Distribution of Safe Routes to School Program Funds, 2005–2012. Am J Prev Med, 45(4), 401-406
- The 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, the study 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.
Noreen C. McDonald a, n, Yizhao Yang b, Steve M. Abbott b, Allison N. Bullock (2013). Impact of the Safe Routes to School program on walking and biking: Eugene, Oregon study. Transport Policy 29 (2013) 243–248, 29, 243-248
- Household and parental characteristics and perceptions of walking and the built environment may reduce the propensity of children to use active travel modes (walking and bicycling) for their school trip.
- This paper examines whether there is a relationship between walking or bicycling to school and the walking habits of caregivers or parents.
- A statewide pedestrian survey of New Jersey residents was used to assess the mode taken by children for their school trip (age of respondents (parents) 19–84; n=353). Socio-demographic characteristics, public school density, full and part-time employment status of respondents, self-reported frequency of walking of adult respondents and perceived neighborhood environment characteristics are used as independent variables. Logit models are estimated to test associations between these variables.
- Non-minority ethnic status, women respondent's employment type, higher income, and vehicle ownership are negatively associated with active travel to school, while higher public school density is positively associated with choice of an active travel mode.
- Even in favorable circumstances for active travel to school, the employment circumstances of parents or caregivers may deter children from walking to school.
- When parents are active, their children are also more likely to be active. Poor sidewalk quality also deters parents from letting children use active modes for their school trip.
Hyunsoo Parka, Robert B. Nolanda. (2013). Active school trips: associations with caregiver walking frequency. Transport Policy, 29, 23-38
- Few reports examined long term predictors of children's active commuting to school (walking or cycling to school, ACS).
- To identify predictors of ACS over one school year among a sample of children with relatively high rates of ACS.
- Parents were surveyed in September 2010 (Time 1) and April 2011 (Time 2). The dependent variable was children's commuting mode to school (active versus passive). Independent variables included: 1) parents' outcome expectations (from Social Cognitive Theory: the expected risks/benefits for their child doing ACS), 2) distance to school, 3) participation in an adult-led walk to school group, 4) temperature, and 5) child demographics. Generalized mixed-models estimated odds ratios for ACS (n=369 or 49.7% of Time 1 respondents).
- ACS was associated with the following:
- males (OR=2.59, 95% CI [1.57-4.30])
- adult-led walk to school group participation (OR=1.80, 95% CI [1.14-2.86])
- parents' outcome expectations (OR=1.26, 95% CI [1.14-1.39])
- temperature (OR=1.03, 95% CI [1.01-1.07)
- distance to school (OR=0.23, 95% CI [0.14-0.37])
- Latino ethnicity (OR=0.28, 95% CI [0.12-0.65]).
- CONCLUSIONS: Programs and policies sensitive to parents' concerns, e.g. adult-led walk to school groups, and targeting Latinos and girls appear promising for increasing ACS.
Mendoza JA, Cowan D, Liu Y. (2013). Predictors of Children's Active Commuting to School: An Observational Evaluation in Five US Communities. J Phys Act Health. Epublished.
- We assessed changes in transit-associated walking in the United States from 2001 to 2009 and documented their importance to public health.
- We examined transit walk times using the National Household Travel Survey, a telephone survey administered by the US Department of Transportation to examine travel behavior in the United States.
- People are more likely to transit walk if they are from lower income households, are non-White, and live in large urban areas with access to rail systems. Transit walkers in large urban areas with a rail system were 72% more likely to transit walk 30 minutes or more per day than were those without a rail system. From 2001 to 2009, the estimated number of transit walkers rose from 7.5 million to 9.6 million (a 28% increase); those whose transit-associated walking time was 30 minutes or more increased from approximately 2.6 million to 3.4 million (a 31% increase).
- Transit walking contributes to meeting physical activity recommendations. Study results may contribute to transportation-related health impact assessment studies evaluating the impact of proposed transit systems on physical activity, potentially influencing transportation planning decisions.
Freeland AL, Banerjee SN, Dannenberg AL, Wendel AM. (2013). Walking associated with public transit: moving toward increased physical activity in the United States. Am J Public Health, 103(3), 536-542. doi: 10.2105/AJPH.2012.300912.
- This study developed and tested an algorithm to classify accelerometer data as walking or non-walking using either GPS or travel diary data within a large sample of adults under free-living conditions.
- Participants wore an accelerometer and a GPS unit, and concurrently completed a travel diary for 7 consecutive days. Physical activity (PA) bouts were identified using accelerometry count sequences. PA bouts were then classified as walking or non-walking based on a decision-tree algorithm consisting of 7 classification scenarios. Algorithm reliability was examined relative to two independent analysts' classification of a 100-bout verification sample. The algorithm was then applied to the entire set of PA bouts.
- The 706 participants' (mean age 51 years, 62% female, 80% non-Hispanic white, 70% college graduate or higher) yielded 4,702 person-days of data and had a total of 13,971 PA bouts. The algorithm showed a mean agreement of 95% with the independent analysts. It classified physical activity into 8,170 (58.5 %) walking bouts and 5,337 (38.2%) non-walking bouts; 464 (3.3%) bouts were not classified for lack of GPS and diary data. Nearly 70% of the walking bouts and 68% of the non-walking bouts were classified using only the objective accelerometer and GPS data. Travel diary data helped classify 30% of all bouts with no GPS data. The mean duration of PA bouts classified as walking was 15.2 min (SD=12.9). On average, participants had 1.7 walking bouts and 25.4 total walking minutes per day.
- GPS and travel diary information can be helpful in classifying most accelerometer-derived PA bouts into walking or non-walking behavior.
Kang B, Moudon AV, Hurvitz PM, et al. (2013). Walking Objectively Measured: Classifying Accelerometer Data with GPS and Travel Diaries. Med Sci Sports Exerc. (e-published).
- Given the health benefits of walking, there is interest in understanding how physical environments favor walking. Although GIS-derived measures of land-use mix, street connectivity, and residential density are commonly combined into indices to assess how conducive neighborhoods are to walking, field validation of these measures is limited.
- To assess the relationship between audit- and GIS-derived measures of overall neighborhood walkability and between objective (audit- and GIS-derived) and participant-reported measures of walkability.
- Walkability assessments were conducted in 2009. Street-level audits were conducted using a modified version of the Pedestrian Environmental Data Scan. GIS analyses were used to derive land-use mix, street connectivity, and residential density. Participant perceptions were assessed using a self-administered questionnaire. Audit, GIS, and participant-reported indices of walkability were calculated. Spearman correlation coefficients were used to assess the relationships between measures. All analyses were conducted in 2012.
- The correlation between audit- and GIS-derived measures of overall walkability was high (R=0.7 [95% CI=0.6, 0.8]); the correlations between objective (audit and GIS-derived) and participant-reported measures were low (R=0.2 [95% CI=0.06, 0.3]; R=0.2 [95% CI=0.04, 0.3], respectively). For comparable audit and participant-reported items, correlations were higher for items that appeared more objective (e.g., sidewalk presence, R=0.4 [95% CI=0.3, 0.5], versus safety, R=0.1 [95% CI=0.003, 0.3]).
- The GIS-derived measure of walkability correlated well with the in-field audit, suggesting that it is reasonable to use GIS-derived measures in place of more labor-intensive audits. Interestingly, neither audit- nor GIS-derived measures correlated well with participants’ perceptions of walkability.
Hajna, Samantha, MSc, Kaberi Dasgupta, MD, MSc, FRCPC, Max Halparin, BA, Nancy A. Ross, PhD. (2012). Neighborhood Walkability: Field Validation of Geographic Information System Measures. American Journal of Preventive Medicine, 44(6), e51-e55. doi: 10.1016/j.amepre.2013.01.033
This report summarizes findings associated with the successful implementation of a Safe Routes to School program in an elementary school in metropolitan Atlanta, GA between 2008–2010.
Elements of the program that led to its success may inform future policy efforts related to active transport to school. This was a multilevel, multi-sector, intervention involving education, community capacity building, enablement and reinforcement through supportive environments and evaluation. Elements and results included:
- Safe Routes to School Task Force: Parent volunteers formed a Safe Routes to School Task Force comprising the school principal, nurse, and physical education teacher, as well as the county police, public works staff, board of health, and a county commissioner. This Task Force formed the basis of a movement to increase social capital at the community, school, family, and the individual level in order to shift the entire school community culture toward one of active transport.
- Education: An informed and engaged community participated on its own behalf. Students, parents, school staff and faculty focused on Safe Routes to School goals of increasing walking roundtrip to school, decreasing traffic, and improving air quality around school. Pedestrian safety education was provided through the Physical Education program. The PTA and local churches were involved. Maps were provided of best walking routes and an extensive publicity campaign was undertaken.
- Various local and federal resources were available to help support community infrastructure projects. Interactive Community Police and infrastructure improvements helped improve safety along routes to school.
- Built environment improvements to increase active transport to school benefited the surrounding community as nearly 40% of communities are within ½ mile of a public school. Five crosswalks were restriped and raised walking intersections and new traffic lights were installed.
- Parental surveys confirmed increased rates of walking to school (18% to 42% in two years) and parental perceptions of health benefits and enjoyment of walking increased. Rates of walking home did not change.
Susan Henderson, Robin Tanner, Normal Klanderman, Abby Mattera, Lindey Martin Webb, John Steward. (2013). Safe Routes to School: A Public Health Practice Success Story—Atlanta, 2008-2010. Journal of Physical Activity and Health, 2013, 10, 141-142.
- This novel interdisciplinary collaboration between public health and computer science provides automatic analysis of existing public data feeds to quantify the impact of built environment intervention on increasing bike travel mode share.
- The Archive of Many Outdoor Scenes (AMOS) has archived over 225 million images of outdoor environments from more than 12,000 public webcams since 2006. Using the publicly available webcams and a custom web crawler (similar to the web search engine or Google), webcam images are captured at the rate of one image per camera per hour and given a time stamp. Many of the locations have had built environment improvements such as complete streets, bike share startups or walking school bus programs. AMOS is able to document and allow quantification of population behavior changes following the built environment modification.
- The intersection of Pennsylvania Ave NW and 9th ST NW in Washington, DC where bike lanes were installed was chosen as a location to monitor transportation mode share comparing the first workweek or June 2009 and the first week of June 2010 (pre-bicycle lane and post-bicycle lane).
- Amazon Mechanical Turk (MTurk) website was used to crowd-source the image annotation. MTurks are simple tasks not yet computer automated. MTurk workers were paid US $0.01, in March 2012 to count each pedestrian, cyclist, and vehicle in a photograph. Each image was counted 5 unique times (n=1200), completed in less than 8 hours. The counts per transportation mode were downloaded to SPSSv.19 for analysis. Results showed a statistically significant difference in transportation mode share between the two years: no significant increase in pedestrians but a four-fold increase in the number of cyclists per scene.
- The investigators conclude that the use of AMOS and MTurks offer an inexpensive ($12.00 for this study) opportunity to quantify behavior change impact following built environment changes. Future plans include monitoring other locations in the Washington DC Capitol Bikeshare program and developing computer algorithms to automate the counting process.
Hipp, J. Aaron; Adlakha, Deepti; Chang, Bill; Eyler, Amy A.; and Pless, Robert B. (2013). "Emerging Technologies: Webcams and Crowd- Sourcing to Identify Active Transportation" (2013). Brown School Faculty Publications (Paper 3).
- The authors indicate that in the United States, development in the past 60 years has turned away from the traditional compact, walkable city or town toward a more dispersed, automobile-centric pattern that makes travel by any means except private vehicle impractical and inconvenient.
- The article explores what makes the United States so different from European countries in which walking and bicycling is more prevalent.
- To plan sustainable—and healthful—human environments, and to determine the most cost-effective measures to encourage more walking and bicycling, more must be known about the various influences on bicycling and walking behavior.
- The article includes an overview of data and planning tools helpful for non-motorized travel, a wide array of walking and bicycling data, an examination of the influence of the natural and built environment, attitudes and perceptions towards walking and bicycling, and questions for future research.
- The article also links to several other publications that may be useful for active transportation practitioners:
- NCHRP Project 8-78 guidebook Estimating Bicycling and pedestrian Demand for Planning and Project Development http://apps.trb.org/cmsfeed/TRBNetProjectDisplay.asp?ProjectID=2707
- American Association of State Highway and Transportation Officials (AASHTO) Guide for the Development of Bicycle Facilities, 4th Edition, https://bookstore.transportation.org/item_details.aspx?ID=1943
- NCHRP (National Cooperative Highway Research Project) Report 500 series Vol 10 and 18 are Guides for Reducing Collisions Involving Pedestrians and a second Guide to Reducing Collisions Involving Bicycles. More information can be found at www.trb.org/Main/Public/Blurbs/152868.aspx
- Traveler Response to Transportation system Changes, Chpt 16: Pedestrian and Bicycle Facilities available online at www.trb.org/Main/Blurbs/167122.aspx
Kuzmyak R. Dill J. (2012). Walking and Bicycling in the United States: The Who, What, Where, and Why. TR News, 280(May/June), 4-17.
- This pilot study examined the effects of a teacher-taught, locomotor skill (LMS)-based physical activity (PA) program on the LMS and PA levels of minority preschooler-aged children.
- Eight low-socioeconomic status preschool classrooms were randomized into LMS-PA (LMS-oriented lesson plans) or control group (supervised free playtime). Interventions were delivered for 30 min/day, five days/week for six months. Changes in PA (accelerometer) and LMS variables were assessed with MANCOVA.
- LMS-PA group exhibited a significant reduction in during-preschool and total daily percent time spent in sedentary activity. LMS-PA group also exhibited significant improvement in leaping skills. No other, significant changes were observed. The implementation of a teacher-taught, LMS-based PA program could potentially improve LMS and reduce sedentary time of minority preschoolers.
Alhassan, S., O. Nwaokelemeh, et al. (2012). "Effects of locomotor skill program on minority preschoolers' physical activity levels." Pediatrc Exercise Science 24(3): 435-449.
- Washington State Department of Transportation released a report that assessed the Safe Routes to School program in five states: Florida, Mississippi, Texas, Washington, and Wisconsin.
- A database of all SRTS projects announced for funding and all schools affected by these projects were developed. The database was analyzed to (1) quantify the SRTS programs’ impact in the five states and compare them to SRTS programs nationally, (2) assess the SRTS programs’ effectiveness in increasing rates of walking and bicycling to school, and (3) identify characteristics of SRTS projects associated with greater increases in walking and bicycling to school.
- The results of this study offer preliminary evidence that the SRTS program is achieving one of its primary goals of increasing rates of walking and bicycling to school and that SRTS funds are delivering a return on investment.
- Key finding from this study: In the five states, more than 1400 schools and 781,000 children have been reached as a result of Safe Routes to School funding; this is roughly 11 percent of the pre-kindergarten through eighth grade public school population in the five states.
- Key finding from this study: Engineering projects made up about 72 percent of the funding in the five states, with sidewalk projects featured in about 69 percent of these projects. Interestingly, the engineering projects that were on smaller scales (affected fewer schools and students) and included encouragement and education components tended to perform better.
- Key finding from this study: Rates of walking increased by 45 percent, bicycling increased by 24 percent, and all active travel to school increased by 37 percent in these five states.
- The study findings suggested that Safe Routes to School projects may be more effective at encouraging bicycling to school where few children already do so.
- Poor lifestyle behaviors, including suboptimal diet, physical inactivity, and tobacco use, are leading causes of preventable diseases globally. Although even modest population shifts in risk substantially alter health outcomes, the optimal population-level approaches to improve lifestyle are not well established.
- In this paper, the authors systematically reviewed and graded the current scientific evidence for effective population approaches to improve dietary habits, increase physical activity, and reduce tobacco use.
- Strategies were considered in 6 broad domains: (1) Media and educational campaigns; (2) labeling and consumer information; (3) taxation, subsidies, and other economic incentives; (4) school and workplace approaches; (5) local environmental changes; and (6) direct restrictions and mandates. The writing group also reviewed the potential contributions of healthcare systems and surveillance systems to behavior change efforts.
- Several specific population interventions were identified, providing a set of specific evidence-based strategies that deserve close attention and prioritization for wider implementation. School-related interventions included increased availability and types of school playground spaces and equipment, increased number of PE classes, and revised PE curricula to increase time in at least moderate activity.
- This systematic review identified and graded the evidence for a range of population-based strategies to promote lifestyle change. The findings provide a framework for policy makers, advocacy groups, researchers, clinicians, communities, and other stakeholders to understand and implement the most effective approaches. New strategic initiatives and partnerships are needed to translate this evidence into action.
Mozaffarian, D., A. Afshin, et al. (2012). Population Approaches to Improve Diet, Physical Activity, and Smoking Habits A Scientific Statement From the American Heart Association. Circulation 126(12):1514-1563.
- The recess environment in schools has been identified as an integral part of school-based programs to enhance physical activity (PA). The purpose of this study was to report pilot findings on the extent to which the Ready for Recess intervention was associated with a different amount of increase in moderate to vigorous PA (MPVA) during recess and the rest of the school day between girls and boys, and between nonwhites and whites.
- The Ready for Recess intervention modified the recess environment of schools by providing staff training and recreational equipment. The MPVA levels of 3rd, 4th, and 5th grade students (n = 93) at 2 schools were measured pre- and post-intervention using ActiGraph accelerometers. Multiple regression models with robust variance were utilized to test for the interaction of intervention with gender and race/ethnicity.
- The intervention was associated with an adjusted increase of 4.7 minutes (P <.001) in moderate/vigorous PA during recess. There was no evidence that this effect varied by gender (P = .944) or race (P = .731). The intervention was also associated with an adjusted increase of 29.6 minutes (P < .001) in moderate/vigorous PA during rest of the school day. While this effect did not vary by gender, there was some evidence (P = .034) that nonwhites benefited more from the intervention than whites.
- Simple strategies such as staff training and recreational equipment may be an effective way to increase PA in children (despite gender or ethnicity) during recess time as well as during the rest of the school day.
Siahpush, M., J. L. Huberty, et al. (2012). Does the Effect of a School Recess Intervention on Physical Activity Vary by Gender or Race? Results From the Ready for Recess Pilot Study. Journal of Public Health Management and Practice 18(5): 416-422.
- This article reports on a study that explored the barriers that prevent parents from allowing their children to commute to school.
- The authors used data from parents of school children in Illinois, U.S., as reported in the National Safe Routes to School Parent Surveys.
- The study finds that the top barriers for both urban and suburban children were intersection safety and traffic speed/volume. Distance from school had a greater impact on the walking or bicycling to school habits of suburban students compared to urban students.
- The authors contend that actively commuting to school gives children the opportunity to explore nature, get exercise, and develop cognitive skills. With the barriers to active commuting to school identified, the Safe Routes to School Programs in Illinois can target their resources effectively to encourage children and their parents to consider walking and biking alternatives for trips to and from school.
Fries, R., E. Sykut, et al. (2012). Barriers Influencing Illinois Children School Travel Mode Choices. Advances in Transportation Studies 27.
- This study examined the relationship between state laws requiring minimum bussing distances, hazardous route exemptions, sidewalks, crossing guards, speed zones, and trafﬁc control measures around schools and active travel to school (ATS) policies and practices in nationally representative samples of U.S. public elementary schools between 2007–2009. The state laws and school data were compiled through primary legal research and annual mail-back surveys of principals, respectively.
- A pooled, cross-sectional analysis examined the relationship between the state laws and the school policies and practices.
- A stacked, cross-sectional data set containing 1967 schools over the combined period, 2007–2009, comprised the ﬁnal study sample (with 578, 749, and 641 schools included in each of the three corresponding study years).
- Multivariate logistic and zero-inﬂated poisson regression indicated that all state law categories (except for sidewalks) relate to ATS. These laws should be considered in addition to formal Safe Routes to School programs as possible inﬂuences on ATS.
- Nearly 40 percent of schools were located in states with minimum bussing distance requirements; 23.4 percent were located in states with hazardous route exemptions.
- More schools allowed all students to walk to school if the state had a minimum bussing distance law of greater than one mile or a law requiring sidewalks or traffic control measures.
- The odds of zero students walking/biking to school were 68 percent lower in states requiring crossing guards and 55 percent lower in states requiring speed zones.
Chriqui, JF, Taber, DR, et al. (2012). “The impact of state safe routes to school-related laws on active travel to school policies and practices in U.S. elementary schools.” Health & Place 18(1): 8-15.
- Walking and bicycling are important but underused modes of transportation in the United States. Road design influences how much walking and bicycling takes place along streets and roads. Currently, numerous national policy initiatives, including Safe Routes to School and Complete Streets, are attempting to improve pedestrian and bicycling infrastructure and “friendliness.” However, no state has completed a systematic assessment of its streets to determine how amenable they are to walking and bicycling. This statewide study was undertaken to assess how accessible and friendly Hawaii roads are to these 2 activities.
- The authors randomly selected street segments in Hawaii’s 4 counties and then completed objective assessments using the Pedestrian Environmental Data Scan. They audited 321 segments, and interrater reliability was adequate across all measures. Streets were coded as high (42.4%) or low capacity (57.6%) depending on how much vehicular traffic the street was designed to accommodate. Outcome measures included street accommodations (ie, sidewalks and crossing aids) and pedestrian and bicyclist use.
- Most high-capacity streets had sidewalks (66%). These sidewalks were usually in good condition, contiguous, and had traffic control devices and pedestrian signals. Most low-capacity roads did not have sidewalks (63.4%). Bicycling facilities were limited (<10%) on both types of roads. Pedestrian and bicycle traffic was related to mixed use, including both residential and retail space, and to pedestrian and bicycling infrastructure.
- Road segments in Hawaii with more infrastructure and types of use, including single-family houses, apartment complexes, restaurants, office buildings, and industrial buildings, are used more by pedestrians and bicyclists.
Maddock JE, Ramirez V, Heinrich KM, Zhang M, Brunner IM. (2012). “A Statewide Observational Assessment of the Pedestrian and Cycling Environment in Hawaii, 2010.” Preventing Chronic Disease.
- This paper examines parents' responses to key factors associated with mode choices for school trips. The research was conducted with parents of elementary school students in Denver Colorado as part of a larger investigation of school travel.
- School-based active travel programs aim to encourage students to walk or bike to school more frequently. To that end, planning research has identified an array of factors associated with parents' decisions to drive children to school. Many findings are interpreted as ‘barriers’ to active travel, implying that parents have similar objectives with respect to travel mode choices and that parents respond similarly and consistently to external conditions. While the conclusions are appropriate in forecasting demand and mode share with large populations, they are generally too coarse for programs that aim to influence travel behavior with individuals and small groups.
- This research uses content analysis of interview transcripts to examine the contexts of factors associated with parents' mode choices for trips to and from elementary school. Short, semi-structured interviews were conducted with 65 parents from 12 Denver Public Elementary Schools that had been selected to receive 2007–08 Safe Routes to School non-infrastructure grants. Transcripts were analyzed using Nvivo 8.0 to find out how parents respond to selected factors that are often described in planning literature as ‘barriers’ to active travel.
- Regular active travel appears to diminish parents' perceptions of barriers so that negotiation becomes second nature. Findings from this study suggest that intervention should build capacity and inclination in order to increase rates of active travel.
Zuniga, Kelly Draper. (2012). “From Barrier Elimination to Barrier Negotiation: A Qualitative Study of Parents’ Attitudes about Active Travel for Elementary School Trips” Transport Policy 20: 75–81.
- Despite efforts to combat increasing rates of childhood obesity, the problem is worsening. Safe Routes to School (SRTS), an international movement motivated by the childhood obesity epidemic, seeks to increase the number of children actively commuting (walking or biking) to school by funding projects that remove barriers preventing them from doing so. This article summarizes the evaluation of the ﬁrst phase of an ongoing SRTS program in California and discusses ways to enhance data collection.
- There is no requirement for funded SRTS programs to submit evaluation data to the California Department of Public Health, but some supply information on a voluntary basis. This study used de-identified data sent to the University of California, San Francisco. The information was on children's school transport modes and parents’ views on active commuting from the Arrival and Departure Tally Sheet and Parent Survey about Walking and Biking to School, instruments developed by the SRTS national center.
- As of October 2010, 20% (n = 42) of grantees from 219 federally funded programs in California had voluntarily submitted evaluation data pertaining to 392 schools, including 63,078 unique parent records.
- Findings: Regardless of weather conditions, day of week, or time of day, the relative pattern of school transport mode was consistent. A majority of children commuted in their family vehicle, and smaller percentages of children walked, carpooled, took the school bus, biked, or used public transportation.
Chaufan, C., Yeh, J., Fox, P. (2012). “The Safe Routes to School Program in California: An Update.” American Journal of Public Health 102(6): e8–e11
- Researchers 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.
- They 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). They 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.
Morency, P., L. Gauvin, et al. (2012). "Neighborhood Social Inequalities in Road Traffic Injuries: The Influence of Traffic Volume and Road Design." American Journal of Public Health 102(6): 1112-1119.
- Although a health impact assessment (HIA) is a tool that can provide decision makers with recommendations to promote positive health impacts and mitigate adverse health impacts of proposed projects and policies, it is not routinely conducted on most major projects or policies.
- To make health a decision criterion for the Atlanta BeltLine, a multibillion-dollar transit, trails, parks, and redevelopment project, a HIA was conducted in 2005–2007 to anticipate and influence the BeltLine's effect on health determinants.
- Changes in access and equity, environmental quality, safety, social capital, and physical activity were forecast, and steps to maximize health benefits and reduce negative effects were recommended.
- Key recommendations included giving priority to the construction of trails and greenspace rather than residential and retail construction, making health an explicit goal in project priority setting, adding a public health professional to decision-making boards, increasing the connectivity between the BeltLine and civic spaces, and ensuring that affordable housing is built. BeltLine project decision makers have incorporated most of the HIA recommendations into the planning process. The HIA was cited in the awarding of additional funds of $7,000,000 for brownfield clean-up and greenspace development. The project is expected to promote the health of local residents more than in the absence of the HIA.
- This report is one of the first HIAs to tie specific assessment findings to specific recommendations and to identifiable impacts from those recommendations. The lessons learned from this project may help others engaged in similar efforts.
Ross, C. L., K. Leone de Nie, et al. (2012). "Health Impact Assessment of the Atlanta BeltLine." American journal of preventive medicine 42(3): 203-213.
- Few adolescents choose to cycle to school in the UK despite the potential health and environmental benefits of the activity. This study sets out to establish the psychological, social and environmental barriers that affect an adolescent's decision to cycle to school.
- Two cross-sectional surveys were distributed, one to pupils aged 11–14 years and one to their parents. Respondents were drawn from a state school for 11–16-year olds in the south of England. Using a Likert scale, respondents were asked to rate barriers to cycling. Fifty-two per cent responded, with 62 households returning both questionnaires.
- Using logistical regression analysis, the investigation found that the probability of a pupil cycling to school decreased when they did not have a friend who cycled to school. Other variables that showed a decreased probability of a child cycling to school were linked to either safety or social issues.
- The findings of this research suggest that social support and road safety could be important predictors for adolescent cycling behavior. Recommendations include promoting initiatives that facilitate social interaction and cyclist safety at the school.
Benson, J. and A. Scriven (2012). "Psychological, social and environmental barriers to cycling to school." International Journal of Health Promotion and Education 50(1): 34-44.
- Walking school buses (WSB) increased children's physical activity, but impact on pedestrian safety behaviors (PSB) is unknown.
- This pilot study demonstrated the feasibility of collecting school-level pedestrian safety behavior outcomes and changes to those outcomes during a WSB program study.
- The WSB was associated with more children crossing at an intersection, but fewer children fully stopping at the curb. These mixed results suggest modification to the WSB program may be necessary in order to improve children's pedestrian safety behaviors on the walk to and from school.
- Further WSB studies, preferably fully powered experimental trials that longitudinally follow participants' pedestrian safety behaviors in the long term, should be conducted in a variety of settings among diverse populations to formally evaluate pedestrian safety and physical activity outcomes. Moreover, studies that examine the influence of the built environment, use objective measures of neighborhood safety, and consider vehicular traffic are also necessary to evaluate their influences on the WSB and children's pedestrian safety.
Mendoza, J. A., K. Watson, et al. (2012). "Impact of a pilot walking school bus intervention on children's pedestrian safety behaviors: A pilot study." Health & Place 18(1): 24-30.
- The school setting could be a primary venue for promoting physical activity among inner-city children due to the structured natured of the school day. The authors examined differences in step counts between structured school days (SSD) and weekend days (WED) among a sample of public school children in Washington, DC.
- Subjects (N = 29) were third- to sixth-grade students enrolled in government-funded, extended-day enrichment programs. Step counts were measured using a pedometer (Bodytronics) over 2 SSD and 2 WED. Differences in mean step counts between SSD and WED were determined using multivariable linear regression, with adjustments for age, sex, and reported distance between house and school (miles).
- Recorded step counts were low on both SSD and WED (7735 ± 3540 and 8339 ± 5314 steps/day). Boys tended to record more steps on SSD compared with girls (8080 ± 3141 vs. 7491 ± 3872 steps/day, respectively), whereas girls recorded more steps on the WED compared with boys (9292 ± 6381 vs. 7194 ± 3669 steps/day). Parameter estimates from the regression modeling suggest distance from school (P < .01) to be the strongest predictor of daily step counts, independent of day (SSD/WED), sex, and age.
- Among inner-city school children, a safe walking route to and from school may provide an important opportunity for daily physical activity.
Goodman, E., W. Evans, et al. (2012). “Preliminary Evidence for School-Based Physical Activity Policy Needs in Washington, DC.” Journal of Physical Activity & Health 9(1): 124-128.
- In 2005, the United States Congress authorized $612 million for use in implementing the US Safe Routes to School program to address physical inactivity, air quality, safety and traffic near schools.
- Each US state developed administrative practices to implement the program. Based on state-specific annual obligations, on average, states have obligated 44% of available funds.
- State project obligations were directly associated with programmatic factors, including broader adherence to federal agency administrative guidance objectives and the number of years for which the states obligated new projects and indirectly associated with student enrollment and state child poverty.
- Overall, $221,229,427 was obligated to implement 2298 SRTS projects in the 50 US states during fiscal years 2005–2009.
- Implementation increased across the fiscal years: $4.99 million was obligated for 6 projects in 2005, $22.09 million for 141 projects in 2006, $45.75 million for 344 projects in 2007, $71.97 million for 949 projects in 2008 and $76.43 million for 858 projects in 2009. Overall percentage increase in obligations between 2006, the first full year of funding, and 2009 was 246%, with annual percentage increase in obligations ranging from 6% (FY2009) to 343% (FY2006).
- On average, states obligated 44% of available funding (range 6–100%). Average per student obligation was $11.07 (range $0.83–$68.05).
- Four states had no county-specific obligations; funding in these states was obligated only to statewide or multi-county projects during the reporting period. Four states had no non-core, rural counties.
- Only 12 states (24%) obligated 50% or more of funds within counties in their state that had child poverty rates above the county median poverty rate for their state.
- Finally, 33 states (66%) made progress on the promotion of comprehensive SRTS programs and activities via state or local practices encouraging the obligation of funding for both infrastructure and non-infrastructure projects.
Cradock, A. L., B. Fields, et al. (2012). "Program practices and demographic factors associated with federal funding for the Safe Routes to School program in the United States." Health & Place 18(1): 16-23.
- This study provided insights on how individual activity-travel patterns of adults were impacted by whether they lived with children or not.
- This cross-sectional study used the 2006 Puget Sound Regional Council Household Activity and Travel Survey data to investigate activity-travel patterns of 7,709 individual adults living in the Puget Sound Region, Washington. Multilevel regression models with the individual as the first level and the household as a second level were developed.
- With one-third of the participants living with children, the results showed that individuals who lived with children made 20% more non-work trips than those who did not live with children. There was no significant difference between the two groups in terms of size of activity realm.
- Whether individuals lived with children or not was found to be an insignificant variable to predict individual automobile dependence.
- The impact of residential density on parents was not different from that of non-parents. Interactions between gender, work status, and whether adults lived with children or not, revealed complex travel patterns according to different population subgroups.
- Women who worked part time and lived with children made the second highest number of non-work trips after women who were unemployed and lived with children. Men who worked part time and lived with children had the largest individual activity realm. Interestingly, men who did not work but lived with children traveled the least.
Lin, L. and A. V. Moudon (2012). The Impacts of Children on the Activity-Travel Patterns of Adults. Paper for the 91st Annual Meeting of the TRB, Washington, DC, January 2012.
- Although being active is vital to the health and well-being of children, increases in physical activity can lead to an elevated risk of injury, which is a leading cause of childhood mortality globally.
- This article provides an overview of the evidence base concerning unintentional injuries associated with popular forms of physical activities for youth, and describes how injury prevention and child obesity professionals can work together to prevent injuries while promoting active lifestyles.
- Policy and environmental interventions that are beneficial to both outcomes are highlighted and recommendations for future research for these complementary areas are also provided.
Pollack, K. M., C. Kercher, et al. (2012). "Toward environments and policies that promote injury-free active living—it wouldn't hurt." Health & Place 18(1): 106-114.