Physical Activity: Interventions to Increase Active Travel to School

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends interventions to increase active travel to school based on evidence they increase walking among students and reduce risks for traffic-related injury.

Economic evidence indicates the economic benefits exceed the cost for active travel to school interventions.

The CPSTF has a related recommendation for combined built environment approaches to increase physical activity.

The full CPSTF Finding and Rationale Statement and supporting documents for Physical Activity: Interventions to Increase Active Travel to School are available in The Community Guide Collection on CDC Stacks.

Intervention

Active travel to school interventions make it easier for children and adolescents to commute to school actively (e.g., walking or biking). They do this by working to improve the physical or social safety of common routes to school or by promoting safe pedestrian behaviors.

In the United States, the most commonly used active travel to school intervention is Safe Routes to School.

Active travel to school interventions must include one or more of the following components:

  • Engineering (e.g., operational and physical improvements to the built environment infrastructure)
  • Education (e.g., materials and activities to teach the importance of active transportation; walking and cycling safety training sessions)
  • Encouragement (e.g., events and activities to promote active transportation)
  • Enforcement (e.g., partnerships with local law enforcement to ensure traffic laws are obeyed in school neighborhoods; crossing guard programs)

Interventions may also include:

  • Evaluation data collection and program monitoring
  • Efforts to ensure components address barriers to participation for all communities (e.g., low-income communities, communities of color) and individuals (e.g., children and parents with disabilities)

Communities typically select or modify intervention components to address specific barriers to active travel. Programs are often combined with other school- and community-based interventions to increase opportunities for physical activity.

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 52 studies (search period through March 2018). The Community Guide review combined studies from a published systematic review (Chillón et al. 2011; 11 studies; search period through January 2010) with studies identified in an updated search (41 studies; search period January 2010 to March 2018).

Study Characteristics

  • Studies were conducted in the United States (24 studies) and other high-income countries
  • Most studies evaluated programs in public elementary or middle schools. Subset analyses showed greater effects at elementary schools than middle schools or high schools
  • Across all studies, the mean student age was 9.8 years and 52.8% of participants were girls
  • Most studies were conducted in urban or mixed urban-suburban communities; none were done in rural communities
  • Study participants ranged from more than 1,000 (22 studies), to between 101-1,000 (16 studies), and 100 or less (10 studies)
  • Study duration ranged from longer than one year (22 studies), to 4-12 months (12 studies), or 3 months or less (14 studies)

Summary of Results

Active Travel to School

Of the 52 studies included in the systematic review, 40 assessed intervention effects on active travel.

  • The proportion of students who walked or bicycled to school increased by a median of 5.9 percentage points (26 studies)
    • The remaining studies used different measures and most reported favorable, though not statistically significant, outcomes (14 studies)
  • A subset of 12 studies evaluated the effectiveness of U.S. Safe Routes to School programs
    • The proportion of students engaged in active travel to school increased by a median of 6.5 percentage points (9 studies)
    • The remaining studies used different measures of change, and most reported favorable, though not statistically significant, outcomes (3 studies)
  • Study results were mixed regarding the amount of moderate to vigorous physical activity children engaged in during active travel (10 studies)
  • There was not enough evidence to show that school travel led to increases in students’ overall daily physical activity

Pedestrian and Bicycling Injuries

Of the 52 studies, 7 assessed intervention effects on pedestrian and bicycling injuries.

  • Five state or city Safe Routes to School programs implemented street-level engineering improvements:
    • New York City over a 10-year period: injuries in census tracts funded for Safe Routes to School programs decreased by 44%
    • Texas (state-wide): pedestrian and bicyclist injury rates among school-age children decreased by 14%
    • Multi-state study (18 states): programs reduced pedestrian and bicyclist injury rates in school-age children by 23%
    • California (state-wide): collisions in Safe Routes to School project areas were reduced by 53%
    • California (state-wide): collisions were reduced by 13% in Safe Routes to School project areas and 15% in non-project areas
  • Two studies examined the impact of specific activities:
    • School crossing guard expansion in Toronto (no effect on injuries)
    • A bicycle safety course in Denmark (mixed results)

Summary of Economic Evidence

Evidence shows economic benefits exceed the cost for active travel to school interventions. The economic review included 10 studies (search period January 1990 through July 2018). Monetary values are expressed in 2017 U.S. dollars.

  • Intervention cost for the three Safe Routes to School programs ranged from $87,150 to $171,863 per school
  • Intervention cost for active travel to school programs outside the United States ranged from $3,531 per school in Australia to $636,622 per project in the United Kingdom
  • The benefit to cost ratios over a 2-year time horizon for the Safe Routes to School programs were 1.46:1.0 and 1.74:1.0 (2 studies)
  • The median benefit to cost ratio for programs outside the United States was 5.2:1.0 over a median 10-year time horizon (5 studies)

Applicability

Based on results from the review, findings should be applicable to most urban and suburban school districts in the United States.

Overall, studies found active travel interventions to be effective regardless of the component or combinations of components selected and implemented (e.g., encouragement, education).

However, interventions that included an engineering component found a larger change in the proportion of students using active travel (5.9 percentage point increase) compared to interventions without an engineering component (4.8 percentage point increase) across similar baselines.

Evidence Gaps

  • What is the relationship between changes in active travel to school and overall measures of total daily physical activity and moderate to vigorous physical activity?
  • How effective are interventions in different U.S. populations and settings such as low income or rural communities?
  • How does intervention effectiveness vary by student demographic characteristics?
  • What is the relationship between local built environment improvements and pedestrian and cycling injury rates?
  • How does the distance students travel between their homes and schools impact intervention effectiveness? Additionally, what is the impact when school buses are offered versus not offered?
  • What are drivers of economic benefits when mode of travel to school shifts from private automobile use to walking or bicycling?
  • What is the percent change in students who choose the active travel mode following U.S. Safe Routes to School implementations?
  • What is the appropriate time horizon for an evaluation of economic benefits?

Implementation Considerations and Resources

The availability of federal and state funding for Safe Routes to School programs has been the primary driver for interventions in the United States.

Safe Routes to School provides additional resources to address particular barriers:

Program planners should consider baseline and follow-up assessments of physical and social barriers specific to the school and neighborhood when selecting and implementing intervention components and activities.

Crosswalks

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.