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Walking and child pedestrian injury: A systematic review of built environment correlates of safe walking
Abstract and Figures
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.
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... Other studies have shown that the access distance to certain uses increases the probability of the presence of different vehicles in that area, followed by an increase in conflicts between vehicles and in. Finally, it leads to crashes (Marshall and Garrick 2011;Quddus 2008), so the type of environmental uses has a significant effect on increasing the frequency of crashes (Ewing and Cervero 2010;Rothman et al. 2014;Stoker et al. 2015). ...
... According to the exponential relationship of the Poisson regression model, an increase of one unit of barren land use area in the local model causes 0.95 units to increase the probability of a crash, which is 0.83 in the global model. The results are consistent with the study (Fuentes et al. 2022;Gomes et al. 2017;Harirforoush and Bellalite 2019;Ikhuoria 1987;Kang 2018;Kazmi et al. 2022;Khaksar et al. 2022;Kim et al. 2010aKim et al. , 2010bKim and Yamashita 2002;Kramer 2005;Kruskal and Wallis 1952;Larson et al. 2012;Le et al. 2020Le et al. , 2022Lee et al. 2013;Leibowicz 2020;Levine et al. 1995;Liu et al. 2017;Marshall and Garrick 2011;Mathew et al. 2022;Matkan et al. 2011;Merlin et al. 2020aMerlin et al. , 2020bMusa and Moses 2014;Nakaya et al. 2014;Ouyang and Bejleri 2014;Peera et al. 2019;Quddus 2008;Rothman et al. 2014;Saccomanno et al. 1997Saccomanno et al. , 2001Srikanth and Srikanth 2020;Stevens 2017;Stoker et al. 2015;Sung et al. 2022;Umair et al. 2022;Wang et al. 2016;Wedagama et al. 2006). ...
... There is less mixing with other uses; in other words, there is a large area of this Users are concentrated in limited traffic areas, which shows that the high share of one user in a traffic area has less effect than mixing types of users in increasing the frequency of crashes. In such a way that traffic areas with one type of land use depending on the type of land use, on average, have a greater effect than traffic areas with mixed land use in increasing the frequency of crashes, as shown in (Duan et al. 2013;Effati and Saheli 2022;Ewing and Cervero 2010;Ewing and Dumbaugh 2009;Fiorentini et al. 2022;Fuentes et al. 2022;Gomes et al. 2017;Harirforoush and Bellalite 2019;Ikhuoria 1987;Kang 2018;Kazmi et al. 2022;Khaksar et al. 2022;Kim et al. 2010aKim et al. , 2010bKim and Yamashita 2002;Kramer 2005;Kruskal and Wallis 1952;Larson et al. 2012;Le et al. 2020Le et al. , 2022Lee et al. 2013;Leibowicz 2020;Levine et al. 1995;Liu et al. 2017;Marshall and Garrick 2011;Mathew et al. 2022;Matkan et al. 2011;Merlin et al. 2020aMerlin et al. , 2020bMusa and Moses 2014;Nakaya et al. 2014;Ouyang and Bejleri 2014;Peera et al. 2019;Quddus 2008;Rothman et al. 2014;Saccomanno et al. 1997Saccomanno et al. , 2001Srikanth and Srikanth 2020;Stevens 2017;Stoker et al. 2015;Sung et al. 2022;Umair et al. 2022) in Table 3, the standard deviation values from the critical value show that all independent variables have spatial correlation, so as expected, the local model has provided more acceptable results than the global model (Almasi and Behnood 2022;Almasi et al. 2021;Aribigbola 2008;Atumo et al. 2022;Bindra et al. 2009;Bozdogan 1987;Cervero and Murakami 2009;Duan et al. 2013;Effati and Saheli 2022;Ewing and Cervero 2010;Ewing and Dumbaugh 2009;Fiorentini et al. 2022;Fuentes et al. 2022;Gomes et al. 2017;Harirforoush and Bellalite 2019;Ikhuoria 1987;Kang 2018;Kazmi et al. 2022;Khaksar et al. 2022;Kim et al. 2010aKim et al. , 2010bKim and Yamashita 2002;Kramer 2005;Kruskal and Wallis 1952;Larson et al. 2012;Le et al. 2020Le et al. , 2022Lee et al. 2013;Leibowicz 2020;Levine et al. 1995;Liu et al. 2017). As mentioned in the methodology section, lower values of AIC, AICc, and BIC and error values indicate a better fit of the model, and adjusted R squared and R squared values closer to 1, the more optimal the model. ...
The type of land use in each traffic area zone (TAZ) is the most important factor determining the number of vehicles, geometric and traffic characteristics in that zone. Any factor in the urban environment that causes congestion and attraction of vehicles at certain times increases the probability of a crash in that area. The purpose of this study is to investigate the effect of the share of different types of uses in various traffic areas of Shiraz city on the probability of a crash. The data collection of this study included 34,588 crash local bases and 37 types of land use, which were scattered in 325 TAZ. Correlation between independent variables in the model causes modeling error, so identifying the independent variables with the greatest effect in estimating the model is very important; so in this study A two-step method, including identifying the types of land uses influencing the occurrence of crashes and evaluating spatial effects between independent variables and crash data have used. In addition, the Kernel density estimate (KDE) method has also been used to find the suitable bandwidth for searching observations. In order to investigate the spatial effects of land use types on crash incidence, geographically weighted regressions (GWRs) and geographically weighted Poisson regressions (GWPRs) were used. Based on the validation criteria, the local GWPR model performs better than the global Poisson model and the local GWR model among the mentioned models. The results of the study have shown the presence of residential, commercial, barren, and abandoned uses, as well as the mixing of residential and non-residential uses. Additionally, significantly impact crashes that the large difference in the area of different types of land use in the scale of TAZ is quite noticeable on the occurrence of crashes. In some TAZ, up to 80% of the area is of one type of land use, so the correct control and management of these land uses has a greater impact on reducing crashes than other land uses.
... Moreover, a study found that children within their neighborhoods and in front of their schools were less likely to be injured when speed bumps were present [85]. According to a systematic review, sidewalks around schools are associated with fewer collisions with children than roads without sidewalks [86]. Another study indicated that there is a greater likelihood of school-aged children being involved in pedestrian collisions on streets with a high proportion of missing sidewalks [81]. ...
... Children's traffic safety is highly influenced by population density and multi-dwelling density based on previous research. Rothman et al. [86] found that high multifamily density decreases the risk of child pedestrian collisions. In addition, children's injuries are negatively correlated with population density in several studies [81]. ...
Purpose of Review
Explore the varied pathways between the built environment and children’s health. The review begins by describing how the built environment and transport infrastructure relate to conditions that lead to health outcomes. The review examines emissions, noise, and traffic dangers in relation to children’s physical, mental, and social health.
Recent Findings
Evidence is increasing for walkable neighborhoods and health-related behavior such as physical activity. However, diverse land uses (often supporting walkability) were also found to increase traffic injuries. Cognitive impacts of motorways on children at schools were found. Finally, the relationships between social activities and built environment are beginning.
Summary
The built environment’s influence on various physical health outcomes is increasingly clear and is often through a transport pathway. However, the links with mental and social health are less developed, though recent findings show significant results. Having accessible child-relevant destinations is an important consideration for children’s health.
... Despite this burden, it remains unclear which policies and interventions are effective in reducing VPIs in LMICs. Some literature reviews have explored this topic, but were either limited to HICs or were not focused on pedestrian victims (8)(9)(10)(11), and there are several urgent reasons to review literature specifically focused on VPIs in LMICs. Firstly, the contexts differ greatly between HICs and LMICs, and, arguably, even between LMICs. ...
Objectives
This scoping study aims to identify environmental road safety measures implemented in low- and middle-income countries (LMICs) to reduce pedestrian injuries from collisions with motor vehicles.
Methods
This review followed Arksey and O’Malley’s approach and reported results using the PRISMA-SCR 2018 checklist. A literature review was conducted in Medline, Google Scholar, and the Transport Research International Documentation database using keyword-derived medical subject heading terms. A total of 14 articles met the pre-established inclusion criteria and were analyzed using a data extraction matrix. The findings were categorized methodically into three prominent themes: (1) methods for reducing pedestrian exposure, (2) traffic calming strategies, and (3) measures for enhancing pedestrian visibility.
Results
Traffic calming strategies, including vehicular speed reduction, roadway contraction, and vertical and horizontal diversionary tactics, emerged as the most effective interventions for reducing pedestrian injuries within LMICs. Conversely, interventions geared towards minimizing pedestrian exposure, such as zebra crossings, crosswalks controlled by traffic signals, underpasses, or overpasses, often produced minimal effects, and occasionally exacerbated the risk of pedestrian accidents. Lack of pedestrian visibility due to density of street vendors and parked vehicles was associated with a higher risk of injuries, while billboards impaired drivers’ attention and increased the likelihood of collisions with pedestrians.
Discussion
In LMICs, the effectiveness of environmental measures in reducing vehicle–pedestrian crashes varies widely. In the face of resource constraints, implementing interventions for pedestrian safety in LMICs necessitates careful prioritization and consideration of the local context.
... We did not find any ecological study evaluating fine-grained neighborhood-level built environment features in relation to pedestrian and bicyclist traffic fatalities using a diverse nationwide sample of U.S. neighborhoods. Several studies have examined associations of built environment with pedestrian/bicyclist safety outcomes at the individual-level (Rothman et al. 2014, Xin et al. 2017 or at the road segment-or intersection-level (Miranda-Moreno et al. 2011, Dai and Jaworski 2016, Mukherjee and Mitra 2022. Such individual-level studies are outside the scope of the present work given our focus on neighborhood-level pedestrian/bicyclist safety outcomes. ...
Walkable neighborhoods provide significant sustainability, health, and motorized user safety benefits. Far less consideration is given to the potential pedestrian/bicyclist safety-related implications of macro-level walkability. Making it desirable to walk and bike without providing the proper physical environment to make it safe is clearly problematic. This study assessed the links between neighborhood walkability and pedestrian/bicyclist traffic fatalities across metropolitan areas in the U.S. We integrated and harnessed geocoded data on pedestrian/bicyclist and all mode traffic fatalities, travel behavior exposures (use of sedentary and active travel modes), sociodemographic, and control variables. Associations of pedestrian/bicyclist traffic fatality rates with walkability characteristics were estimated using multilevel Tobit models with treatment for hierarchical unobserved regional and state variations. Walkability index (mixed land use, street intersection density, and transit accessibility) was positively correlated with pedestrian/bicyclist fatality rates after adjusting for travel exposures, sociodemographic controls, and regional and state-level unobserved variations. A unit increase in the walkability index was associated with a 4.9% increase (95% CI: 4.2%, 5.7%) in pedestrian/bicyclist fatality rates. Conversely, the walkability index was negatively correlated with total or all-mode fatality rates. The positive association between walkability and pedestrian/bicyclist fatality rates appeared robust in different sensitivity analyses. Despite non-linearities, neighborhoods with greater population using active travel modes for commute had on-average higher pedestrian/bicyclist fatality rates. The reverse was true for neighborhoods with greater teleworking population. Neighborhoods with greater prevalence of black, low-income, and younger adults had on-average higher pedestrian/bicyclist fatality rates. Results emphasize the need to develop new conceptual definitions of walkability that consider safety within the built environments. Our results highlight the importance of understanding how pedestrian/bicyclist supportive design can be used to maximize the positive health benefits of walkability while reducing the risk of pedestrian/bicyclist deaths. Findings also suggest the need to enhance existing walkability assessment techniques (indices) to predict and simulate how different investments impact pedestrian/bicyclist safety. Incorporation of objective pedestrian/bicyclist safety in walkability assessments can assist practitioners to simultaneously improve health while minimizing safety risks to vulnerable road users.
... influence on walking suitability and an important determinant of physical activity and walking to school in children and adolescents, and there is a significant correlation between perceived traffic safety and walking activity, and this association is stronger in girls than in boys 4 . And reducing traffic volume and traffic speed and increasing children's recreational areas have been shown to be important measures to increase walking safety for children and adolescents 5 . In terms of obesity prevention: physical activity can improve children's health including obesity 6 and cardiorespiratory health 7 . ...
The study of walkability is of great significance to the construction of healthy cities. In this paper, taking 1283 articles of walkability, which were included in Web of Science, as the research object. This paper adopts to analysis the research progress by using the method of scientometrics and knowledge networks analysis. Objectively and systematically analyze the research progress of walkability abroad from the aspects of publication overview, knowledge foundation, research direction and hot spots, etc. It is found that foreign researches on walkability mainly include three core directions: walkability and physical activity, walkability evaluation, walkability and urban design. Among them, walkability and physical activity orientation have been studied from various perspectives, such as various groups, various environmental types, different behavioral patterns and various chronic diseases. With the increasingly prominent urbanization problems and the rapid development of new technologies, multiple data, new methods and interdisciplinary cooperation will actively promote the vigorous development of walking suitability research.
... Furthermore, the already existing data are not representative of low-and-middle-income countries, although the burden of CVD is much higher in these countries. [5,[12][13][14][15][16][17] Hence, this study was conducted with the specific aims of assessing the environmental risk factors that unfavorably contribute to CVD risk-related behaviors in an urban underprivileged area of Bengaluru, India, and to assess the knowledge and attitude of residents in the community about environmental risk factors for CVD. ...
Background: Cardiovascular disease (CVD), a growing epidemic, is influenced by various environmental factors, and the potential connection is not studied adequately.
Objective: Hence, our study was aimed at assessing the environmental risk factors for CVD and assessing perceptions about the same among the adults residing in an urban slum, Bengaluru.
Methods: A cross‐sectional descriptive study was conducted using a validated environmental assessment tool – Environmental Profile of Community Health. It consists of two parts: (i) an assessment of the physical environment for CVD-risk behaviors and (ii) a questionnaire to collect residents’ perceptions of their community’s environmental risks for CVD.
Results: The community had two environmental risk factors for CVD‐tobacco stores and fast‐food restaurants. The community had ten convenience stores, all of which sold tobacco products. Vegetables and fruits were available, and the community also had a park for recreation. We interviewed a total of four study participants with a mean age of 38.5 ± 5.4 years. All participants reported that they have seen people smoke outside public places and inside residences. They felt that society disapproved of women and children smoking while men were excluded. Study participants have reported seeing tobacco and junk food advertisements. Tobacco was easily accessible and available to all ages. Conclusions: The urban community was not CVD‐friendly. Awareness regarding risk factors for CVD was good. Adequate urban planning, policy‐level advocacy, and tailor‐made lifestyle changes for patients are the key to preventing CVD.
... Separated and protected cycling infrastructure has also been shown to reduce collisions and injury associated with AT [76,77]. Most of the evidence on built environment features associated with safety and AT is cross-sectional [78], and there continues to be a need for evaluation of the effect of built environment changes (e.g., street environments, walking and cycling infrastructure) not only on use and PA, but also on reduction in vehicle travel and pedestrian injury [79]. Vision Zero is a global initiative trying to address safety using a systems approach with a goal to have zero fatalities or serious injuries as a result of road traffic accidents [80]. ...
Background
The growth of urban dwelling populations globally has led to rapid increases of research and policy initiatives addressing associations between the built environment and physical activity (PA). Given this rapid proliferation, it is important to identify priority areas and research questions for moving the field forward. The objective of this study was to identify and compare research priorities on the built environment and PA among researchers and knowledge users (e.g., policy makers, practitioners).
Methods
Between September 2022 and April 2023, a three-round, modified Delphi survey was conducted among two independent panels of international researchers (n = 38) and knowledge users (n = 23) to identify similarities and differences in perceived research priorities on the built environment and PA and generate twin ‘top 10’ lists of the most important research needs.
Results
From a broad range of self-identified issues, both panels ranked in common the most pressing research priorities including stronger study designs such as natural experiments, research that examines inequalities and inequities, establishing the cost effectiveness of interventions, safety and injuries related to engagement in active transportation (AT), and considerations for climate change and climate adaptation. Additional priorities identified by researchers included: implementation science, research that incorporates Indigenous perspectives, land-use policies, built environments that support active aging, and participatory research. Additional priorities identified by knowledge users included: built environments and PA among people living with disabilities and a need for national data on trip chaining, multi-modal travel, and non-work or school-related AT.
Conclusions
Five common research priorities between the two groups emerged, including (1) to better understand causality, (2) interactions with the natural environment, (3) economic evaluations, (4) social disparities, and (5) preventable AT-related injuries. The findings may help set directions for future research, interdisciplinary and intersectoral collaborations, and funding opportunities.
Background
Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low‐ and middle‐income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high‐income countries have successfully reduced RTI by using a public health approach and implementing evidence‐based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high‐income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge.
Objectives
The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels.
Search Methods
The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019.
Selection Criteria
The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post‐crash pre‐hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non‐fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes.
Data Collection and Analysis
The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case‐control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2.
Main Results
The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post‐crash pre‐hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non‐fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety‐six percent of the studies were reported from high‐income countries (HIC), 4.5% from upper‐middle‐income countries, and only 1.4% from lower‐middle and low‐income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality.
Authors' Conclusions
The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence‐synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.
Introduction:
The Safe Routes to School (SRTS) program is designed to encourage active and safe transportation for children to school. This report examines the potential broader impact of these programs on communities within 0.5 mile (0.8 km) of schools.
Methods:
We used a geographic information system to generate estimates of the land area within 0.5 mile of public schools in 4 U.S. Census-defined categories: 37 large urban areas, 428 small urban areas, 1088 metropolitan counties (counties in metropolitan statistical areas excluding the urban areas), and 2048 nonmetropolitan counties. We estimated population at the county level or at the U.S. Census-defined urban-area level using data from the 2000 U.S. Census.
Results:
In large urban areas, 39.0% of the land area was within 0.5 mile of a public school, and in small urban areas, 26.5% of the land area was within 0.5 mile of a public school. An estimated 65.5 million people in urban areas could benefit from SRTS projects. In nonurban areas, 1% or less of land is within 0.5 mile of a public school.
Conclusion:
Results suggest that SRTS projects in urban areas can improve the walking and bicycling environment for adults as well as for children, the target users. Investment in SRTS can contribute to increased physical activity among children and adults.
Introduction:
Driven largely by international declines in rates of walking and bicycling to school and the noted health benefits of physical activity for children, research on children's active commuting to school has expanded rapidly during the past 5 years. We summarize research on predictors and health consequences of active commuting to school and outline and evaluate programs specific to children's walking and bicycling to school.
Methods:
Literature on children's active commuting to school published before June 2007 was compiled by searching PubMed, PsycINFO, and the National Transportation Library databases; conducting Internet searches on program-based activities; and reviewing relevant transportation journals published during the last 4 years.
Results:
Children who walk or bicycle to school have higher daily levels of physical activity and better cardiovascular fitness than do children who do not actively commute to school. A wide range of predictors of children's active commuting behaviors was identified, including demographic factors, individual and family factors, school factors (including the immediate area surrounding schools), and social and physical environmental factors. Safe Routes to School and the Walking School Bus are 2 public health efforts that promote walking and bicycling to school. Although evaluations of these programs are limited, evidence exists that these activities are viewed positively by key stakeholders and have positive effects on children's active commuting to school.
Conclusion:
Future efforts to promote walking and bicycling to school will be facilitated by building on current research, combining the strengths of scientific rigor with the predesign and postdesign provided by intervention activities, and disseminating results broadly and rapidly.
Regular active commuting by walking/cycling can help maintain an active lifestyle. The frequency, duration and correlates of school active commuting were examined for primary school children in NSW, Australia. Walking/cycling-only and in combination with bus/car were of short duration (median 7 or 4 min, respectively) and their frequency dropped within a short distance (>0.75 km) from school. Apart from distance, child's age, school affiliation and perceived safety, regular walking/cycling (10 trips, 22%) was associated with parents' travel mode to work and with father taking the child to school. Frequent walking/cycling (5 trips, 37%) was associated with child's level of independence and the perceived benefits of active commuting. Behaviour change in this setting requires multi-level strategies.
Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users.
Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement—a reporting guideline published in 1999—there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions.
The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (http://www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.
Walking or bicycling to school could contribute to children's daily physical activity, but physical environment changes are often needed to improve the safety and convenience of walking and cycling routes. The California Safe Routes to School (SR2S) legislation provided competitive funds for construction projects such as sidewalks, traffic lights, pedestrian crossing improvements, and bicycle paths.
A cross-sectional evaluation examined the relationship between urban form changes and walking and bicycle travel to school. Surveys were distributed to parents of third- through fifth-grade children at ten schools that had a completed SR2S project nearby. Two groups were created based on whether parents stated that their children would pass the SR2S project on the way to school or not.
Children who passed completed SR2S projects were more likely to show increases in walking or bicycle travel than were children who would not pass by projects (15% vs 4%), based on parents' responses.
Results support the effectiveness of SR2S construction projects in increasing walking or bicycling to school for children who would pass these projects on their way to school.
Despite the great amount of prevention, child pedestrian victims in school context in Montreal remained almost constant from 1999 to 2003. On the other hand, the elementary public school environment has been barely taken into account in research on factors affecting the risk of accident of these vulnerable users. The objective of this paper is to explore the influence of different socioeconomic and environmental variables on child pedestrian risk through the modeling of the surroundings of the school. The proposed methodology uses geographic information system and geographically weighted Poisson regression (GWPR). Five variables are positively associated with pedestrian risk around schools: number of school crossing guards, land use diversity, residential density, deprivation and population density (children). GWPR permitted to demonstrate the local variations of risk factors throughout the island of Montreal. Moreover, the better knowledge of these variations can potentially help public policy makers to address local realities in more efficient interventions planning.
Rising rates of overweight children have focused attention on walking and biking to school as a means to increase children's physical activity levels. Despite this attention, there has been little documentation of trends in school travel over the past 30 years or analysis of what has caused the changes in mode choice for school trips.
This article analyzes data from the 1969, 1977, 1983, 1990, 1995, and 2001 National Personal Transportation Survey conducted by the U.S. Department of Transportation to document the proportion of students actively commuting to school in aggregate and by subgroups and analyze the relative influence of trip, child, and household characteristics across survey years. All analyses were done in 2006.
The National Personal Transportation Survey data show that in 1969, 40.7% (95% confidence interval [CI]=37.9-43.5) of students walked or biked to school; by 2001, the proportion was 12.9% (95% CI=11.8-13.9). Distance to school has increased over time and may account for half of the decline in active transportation to school. It also has the strongest influence on the decision to walk or bike across survey years.
Declining rates of active transportation among school travelers represents a worrisome loss of physical activity. Policymakers should continue to support programs designed to encourage children to walk to school such as Safe Routes to School and the Centers for Disease Control and Prevention's KidsWalk. In addition, officials need to design policies that encourage schools to be placed within neighborhoods to ensure that the distance to school is not beyond an acceptable walking distance.
Recently created policies and programs target urban form as a primary factor in changes in children’s travel behavior to school. Unfortunately, little research exists that supports a direct relationship between urban form and a child’s trip to school. This article first discusses the transportation and health problems these policies attempt to address. It then reviews the current planning and public health literature on the relationship between urban form and children’s travel behavior. Finally, a conceptual framework is outlined that addresses the complexity of the relationship between urban form and a child’s trip to school to guide future policy and research.
... con- ducted in as little as ten-minute bouts three times a day —the equivalent of ... Boarnet and Crane 2001; Boarnet and Sarmiento 1998; Crane and Crepeau 1998; Boarnet and Greenwald ... per- sonal health and the environment, discomfort, and no knowledge of safe travel routes ...