Physical Activity: Interventions to Increase Active Travel to School

The CPSTF finding is based on evidence from a systematic review of 52 studies (search period through March 2018) that evaluated the impact of active travel to school interventions on students’ commuting patterns. The Community Guide review combined studies from a published systematic review (Chill n et al. 2011; 11 studies; search period through January 2010) with studies identified in an updated search that used the same terms (41 studies; search period January 2010 to March 2018).

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to increasing physical activity or preventing pedestrian injuries.

Physical activity among children is a public health priority (USDHHS, 2008a). The U.S. Department of Health and Human Services recommends that young people ages 6 17 years participate in at least 60 minutes of physical activity daily (USDHHS, 2008b, 2018b).

Regular physical activity in childhood and adolescence improves strength and endurance, helps build healthy bones and muscles, helps control weight, reduces symptoms of anxiety and depression, and may improve cardiovascular health (USDHHS, 2008a, 2018a). Walking or bicycling to and from school provides children and adolescents with an opportunity to be physical active.

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

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 to evaluate active travel, 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 with regard to 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 included in the systematic review, 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% during the program study period.
  • 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 of the seven included studies examined the impact of specific activities:
  • School crossing guard expansion in Toronto (no effect on injuries)
  • A bicycle safety course in Demark (mixed results)

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

Evidence shows economic benefits exceed the cost for active travel to school interventions. The economic review included 10 studies (search period January 1990 July 2018) that targeted elementary and middle schools. 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 the programs outside the United States was 5.2:1.0 over a median 10-year time horizon (5 studies).

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, the subset of study 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.

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are 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?

• Included studies were conducted in the United States (24 studies) and other high-income countries.
• Most of the 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 1000 (22 studies), to between 101-1000 (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).

Jacob V, Chattopadhyay SK, Reynolds JA, et al. Economics of Interventions to Increase Active Travel to School: A Community Guide Systematic Review. American Journal of Preventive Medicine 2021;60(1):e27-40.

Petersen R, Pedroso MS. Economic Benefits of Promoting Safe Walking and Biking to School: Creating Momentum for Community Improvements. American Journal of Preventive Medicine 2021;60(1):e41-3.

Effectiveness Review

Analytic Framework

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Economic Review

No content is available for this section.

Effectiveness Review

No content is available for this section.

Economic Review

Summary Evidence Table – Economic Review

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications)..

Effectiveness Review

Boarnet MG, Day K, Anderson C, McMillan T, Alfonzo M. California’s Safe Routes to School program: impacts on walking, bicycling and pedestrian safety. Journal of the American Planning Association 2005;71(3):301-17.

B rrestad LAB, stergaard L, Andersen LB, Bere E. Experiences from a randomised, controlled trial on cycling to school: does cycling increase cardiorespiratory fitness? Scandinavian Journal of Public Health 2012;40:245 52.

Buckley A, Lowry MB, Brown H, Barton B. Evaluating safe routes to school events that designate days for walking and bicycling. Transport Policy 2013;30:294-300.

Buliung R, Faulkner G, Beesley T, Kennedy J. School travel planning: mobilizing school and community resources to encourage active school transportation. Journal of School Health 2011;81:704-12.

Bungum TJ, Clark S, Aguilar B. The Effect of an active transport to school intervention at a suburban elementary school. American Journal of Health Education 2014;45:4.

Christiansen LB, Toftager M, Ersb ll AK, Troelsen J. Effects of a Danish multicomponent physical activity intervention on active school transport. Journal of Transport & Health 2014;1(3):174-81.

Coombes E, Jones A. Gamification of active travel to school: A pilot evaluation of the Beat the Street physical activity intervention. Health & Place 2016;39:62 9.

Crawford S, Garrard J. A combined impact-process evaluation of a program promoting active transport to school: understanding the factors that shaped program effectiveness. Journal of Environmental and Public Health 2013;2013:14p.

DiMaggio et al. National Safe Routes to School program and risk of school-age pedestrian and bicyclist injury. Annals of Epidemiology 2016;26:412-17.

DiMaggio et al. Association of the Safe Routes to School program with school-age pedestrian and bicyclist injury risk in Texas. Injury Epidemiology 2015;2:15.

DiMaggio C, Li G. Effectiveness of a safe routes to school program in preventing school-aged pedestrian injury. Pediatrics 2013;131(2):290-6.

Ducheyne F, De Bourdeaudhuij I, Lenoir M, Cardon G. Effects of a cycle training course on children’s cycling skills and levels of cycling to school. Accident Analysis & Prevention 2014;67:49-60.

Duncan S, McPhee JC, Schluter PJ, Zinn C, Smith R, Schofield G. Efficacy of a compulsory homework programme for increasing physical activity and healthy eating in children: the healthy homework pilot study. International Journal of Behavioral Nutrition and Physical Activity 2011;8(1):127.

Folta SC, Kuder JF, Goldberg JP, Hyatt RR, Must A, Naumova EN, Nelson ME, Economos CD. Changes in diet and physical activity resulting from the Shape Up Somerville community intervention. BMC Pediatrics 2013;13(1):157.

Ginja S, Arnott B, Araujo-Soares V, Namdeo A, McColl E. Feasibility of an incentive scheme to promote active travel to school: a pilot cluster randomised trial. Pilot and Feasibility Studies 2017;3(1):57.

Goodman A, van Sluijs EM, Ogilvie D. Impact of offering cycle training in schools upon cycling behaviour: a natural experimental study. International Journal of Behavioral Nutrition and Physical Activity 2016;13(1):34.

Gutierrez CM, Slagle D, Figueras K, Anon A, Huggins AC, Hotz G. Crossing guard presence: impact on active transportation and injury prevention. Journal of Transport and Health 2014;1(2):116-23.

Gyergyay PB. New ways of encouraging an old form of mobility. Incentivisation of walking to school in London. Revista Bit cora Urbano Territorial 2012;21(2).

Heelan KA, Abbey BM, Donnelly JE, et al. Evaluation of a walking school bus for promoting physical activity in youth. Journal of Physical Activity and Health 2009;9:560-7.

Henderson S, Tanner R, Klanderman N, Mattera A, Martin Webb L, Steward J. Safe Routes to School: a public health practice success story Atlanta, 2008 2010. Journal of Physical Activity and Health 2013;10:141-2.

Hinckson EA, Badland HM. School travel plans: Preliminary evidence for changing school-related travel patterns in elementary school children. American Journal of Health Promotion 2011;25(6):368-71.

Hoelscher D, Ory M, Dowdy D, Miao J, Atteberry H, et al. Effects of funding allocation for safe routes to school programs on active commuting to school and related behavioral, knowledge, and psychosocial outcomes: results from the Texas childhood obesity prevention policy evaluation (T-COPPE) study. Environment and Behavior 2016;48(1):210-29.

Hunter RF, de Silva D, Reynolds V, Bird W, Fox KR. International inter-school competition to encourage children to walk to school: a mixed methods feasibility study. BMC Research Notes 2015;8(1):19.

Johnson R, Frearson M, Hewson P. Can bicycle training for children increase active travel. Proceedings of the Institution of Civil Engineers. 2015 Aug 6. 9p. [Johnson R, Frearson M, Hewson P. Can bicycle training for children increase active travel? Proceedings of the Institution of Civil Engineers – Engineering Sustainability 2016;169(2):49-57.]

Kong AS, Sussman AL, Negrete S, Patterson N, Mittleman R, Hough R. Implementation of a walking school bus: lessons learned. Journal of School Health 2009;79(7):319-25.

Lambe B, Murphy N, Bauman A. Active travel to primary schools in Ireland: an opportunistic evaluation of a natural experiment. Journal of Physical Activity and Health 2017;14(6):448-54.

Malakellis M, Hoare E, Sanigorski A, Crooks N, Allender S, et al. School based systems change for obesity prevention in adolescents: outcomes of the Australian Capital Territory ‘It’s Your Move!’. Australian and New Zealand Journal of Public Health 2017;41(5):490-6.

Mammen G, Stone MR, Faulkner G, Ramanathan S, Buliung R, et al. Active school travel: an evaluation of the Canadian school travel planning intervention. Preventive Medicine 2014;60:55-9.

McDonald NC, Steiner RL, Lee C, Smith TR, Zhu X, Yang Y. Impact of the Safe Routes to School program on walking and biking. Journal of the American Planning Association 2014;80(2):153-67.

McDonald NC, Yang Y, Abbott SM, Bullock AN. Impact of the Safe Routes to School program on walking and biking: Eugene, Oregon study. Transport Policy 2013;29:243-8.

Mckee R, Mutrie N, Crawford F, Green B. Promoting walking to school: results of a quasi-experimental trial. J Epidemiol Community Health 2007;61;818-23.

McMinn D, Rowe DA, Murtagh S, Nelson NM. The effect of a school-based active commuting intervention on children’s commuting physical activity and daily physical activity. Preventive Medicine 2012;54(5):316-18.

Mendoza JA, Haaland W, Jacobs M, Abbey-Lambertz M, Miller J, Salls D, Todd W, Madding R, Ellis K, Kerr J. Bicycle trains, cycling, and physical activity: a pilot cluster RCT. American Journal of Preventive Medicine 2017;53(4):481-9.

Mendoza JA, Levinger DD, Johnston BD. Pilot evaluation of a walking school bus program in a low-income, urban community. BMC Public Health 2009;9(1):122

Mendoza JA, Watson K, Baranowski T, Nicklas TA, Uscanga DK, Hanfling MJ. The walking school bus and children’s physical activity: a pilot cluster randomized controlled trial. Pediatrics 2011;128(3):e537-44.

Millar L, Kremer P, de Silva Sanigorski A, McCabe MP, Mavoa H, et al. Reduction in overweight and obesity from a 3-year community-based intervention in Australia: the ‘It’s Your Move!’project. Obesity Reviews 2011;12(s2):20-8.

Orenstein MR, Gutierrez N, Rice TM, Cooper JF, Ragland DR. Safe Routes to School Safety and Mobility Analysis: Report to the California Legislature. California Department of Transportation and University of California Traffic Safety Center; 2007.

stergaard L, St ckel JT, Andersen LB. Effectiveness and implementation of interventions to increase commuter cycling to school: a quasi-experimental study. BMC Public Health 2015;15(1):1199.

Ragland D, Pande S, Bigham J, Cooper J. Ten years later: examining long-term impact of California Safe Routes to School Program. In: Proceedings of the Transportation Research Board 93rd Annual Meeting, Transportation Research Board; 2014.

Rothman L, Perry D, Buliung R, Macarthur C, To T, et al. Do school crossing guards make crossing roads safer? A quasi-experimental study of pedestrian-motor vehicle collisions in Toronto, Canada. BMC Public Health 2015;15(1):732.

Rowland D, DiGuiseppi C, Gross M, et al. Randomised controlled trial of site specific advice on school travel patterns. Archives of Disease in Childhood 2003;88:8-11.

Sirard JR, Alhassan S, Spencer TR et al. Changes in physical activity from walking to school. Journal of Nutrition Education and Behavior 2008;40(5):324-6.

Staunton Ce, Hubsmith D, Kallins W. Promoting safe walking and biking to school: the Marin County success story. Field Action Report 2003;93(9):1431-4.

Stewart O, Moudon AV, Claybrooke C. Multistate evaluation of safe routes to school programs. American Journal of Health Promotion 2014;28(3_suppl):S89-96.

TenBrink DS, McMunn R, Panken S. Project U-Turn: Increasing active transportation in Jackson, Michigan. American Journal of Preventive Medicine 2009;37(6S2);S329-35.

Vanwolleghem G, D’Haese S, Van Dyck D, De Bourdeaudhuij I, Cardon G. Feasibility and effectiveness of drop-off spots to promote walking to school. International Journal of Behavioral Nutrition and Physical Activity 2014;11(1):136.

Villa-Gonz lez E, Ruiz JR, Ward DS, Chill n P. Effectiveness of an active commuting school-based intervention at 6-month follow-up. European Journal of Public Health 2015;26(2):272-6.

Wen LM, Fry D, Merom D, Rissel C, Dirkis H, Balafas A. Increasing active travel to school: are we on the right track? A cluster randomized controlled trial from Sydney, Australia. Preventive Medicine 2008; 47;612-8.

Economic Review

Davis A. Claiming the Health Dividend: A Summary and Discussion of Value for Money Estimates from Studies of Investment in Walking and Cycling. Department of Transport, London. November 2014. (Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/371096/claiming_the_health_dividend.pdf)

Fishman E, Garrard J, Ker I, Litman T. Cost and Health Benefit of Active Transport in Queensland: Research and Review, Stage One Report. Prepared by CATALYST for Health Promotion Queensland. May 2011. (Available from: https://sensibletransport.org.au/wp-content/uploads/2015/10/QLD-Health-Stage-1-Report-Full-10.09.11.compressed.pdf) (Linked to Ker 2011)

Ker I, Fishman E, Garrard J, Litman T. Cost and Health Benefit of Active Transport in Queensland: Evaluation Framework and Values, Stage Two Report. Prepared by CATALYST for Health Promotion Queensland. September 2011. (Available from: https://sensibletransport.org.au/wp-content/uploads/2015/10/QLD-Health-Stage-2-HR_V4.pdf) (Linked to Fishman 2011)

Marjory M, Haby M, Galvin L, Swinburn B, Carter R. Cost-effectiveness of active transport for primary school children-Walking School Bus program. International Journal of Behavioral Nutrition and Physical Activity 2009;6(1):63.

Moodie M, Haby M, Swinburn B, Carter R. Assessing cost-effectiveness in obesity: active transport program for primary school children TravelSMART Schools Curriculum Program. Journal of Physical Activity and Health 2011;8:503-15.

Moudon AV, Stewart O. Moving Forward: Safe Routes to School Progress in Five States. Research Report: Agreement T4118 Task 37, Washington State Department of Transportation, Olympia, Washington. July 2012. (Available at: https://www.wsdot.wa.gov/research/reports/fullreports/743.3.pdf) (Linked to Stewart 2012)

Muennig PA, Epstein M, Li G, DiMaggio C. The cost-effectiveness of New York City’s safe routes to school program. American Journal of Public Health 2014;104(7):1294-9.

Orenstein OR, Gutierrez N, Rice TM, et al. Safe Routes to School: Safety and Mobility Analysis. Report to the California Legislature, January 2007. (Available at: https://escholarship.org/uc/item/5455454c)

University of Toronto. School Travel Planning Benefit-cost Report for Toronto & Wellington-Dufferin-Guelph. February 2016. (Available from: http://ontarioactiveschooltravel.ca/wp-content/uploads/2017/08/Benefit-Cost-Final-Report-2016.pdf)

Stewart O, Moudon AV, Claybrooke C. Multistate evaluation of Safe Routes to School programs. American Journal of Health Promotion 2014;28(3_suppl):S89-96. (Linked to Moudon 2012)

Sustrans. Improving access for Local Journeys Linking Communities 2012-13 programme-wide impacts. Department of Transport. Sustrans, Bristol. July 2014. (Available from: https://www.sustrans.org.uk/sites/default/files/file_content_type/improving_access_for_local_journeys_report_final.pdf)

Yamaguchi T, Kawakami S. A study on contingent valuation of transport accessibility improvement. Studies in Regional Science 2007;37(4):979-94.

Other References

Boarnet MG, Anderson CL, Day K, McMillan T, Alfonzo M. Evaluation of the California Safe Routes to School legislation: urban form changes and children’s active transportation to school. American Journal of Preventive Medicine 2005;28(2 Suppl 2):134-40.

Boarnet MG, Day K, Anderson C, McMillan T, Alfonzo M. California’s Safe Routes to School program: impacts on walking, bicycling and pedestrian safety. Journal of the American Planning Association 2005;71(3):301-17. (Linked to Orenstein 2007)

Implementation Resources

Actionable Public Health Strategies to Boost Community Well-Being with Safe Routes to Parks
Developed by the Safe Routes Partnership

CDC’s High-Impact in 5 years initiative recommends Safe Routes to School interventions based on evidence that shows they increase active travel and reduce pedestrian and bicycle injuries within five years and have economic value.

County Health Rankings & Roadmaps identifies Safe Routes to School programs as scientifically supported based on evidence that shows they increase active travel to school and reduce in injuries.

BE Active: Connecting Routes + Destinations is a set of resources and guidelines CDC’s Division of Nutrition, Physical Activity, and Obesity designed to help communities implement combined built environment approaches. Materials include Real World Examples, an Implementation Resource Guide, a Visual Guide, and a slideshow that public health professionals can use to talk with others about enhancing the built environment.

Rural Health Information Hub, Transportation Toolkit
This toolkit compiles information, resources, and best practices to support development and implementation of transportation programs in rural communities. Modules include program models, implementation and evaluation resources, and funding and dissemination strategies.

• Active Transportation Models

Effectiveness Review

The CPSTF finding is based on evidence from a systematic review of 52 studies (search period through March 2018) that evaluated the impact of active travel to school interventions on students’ commuting patterns. The Community Guide review identified 11 studies from a published systematic review (search period through January 2010).

Chill n P, Evenson KR, Vaughn A, et al. A systematic review of interventions for promoting active transportation to school. International Journal of Behavioral Nutrition and Physical Activity 2011;8(1):10.

The Community Guide coordinated an updated search for evidence using search terms adapted from Chillon 2011 et al. Forty-one additional studies were identified (search period January 2010 to March 2018).

Searched databases covered publications in biomedical, behavioral, environmental, and transportation sciences. The types of documents searched in the databases included journal articles, books, book chapters, reports, conference papers, and dissertations.

Search strategies were adjusted to each database, based on controlled and uncontrolled vocabularies and search software. Members of the systematic review team also scanned the bibliographies of all included studies to identify any additional relevant literature.

PubMed

#1 (pedestrian* or transport* or active or walk*[title/abstract] or walk*[mesh] OR Bike OR bikers OR biking OR bicycle or bicycled or bicycles or bicycling OR cycling OR cyclist* OR commute* OR commuting OR OR travel*)

#2 (policy or policies OR preparation OR promotion* OR program* or “physical environment” OR pilot OR project OR planning or “built environment” or environment* OR evaluat* OR engineer* OR encourage* OR education or equity or enforcement or intervention* OR implement* OR change OR impact OR “walk to school” OR “safe routes to school” OR “walking schoolbus” OR “walking school bus” OR “walking school buses”)

#3 (“school”[Title/Abstract])

#4 “United Kingdom” OR “United States” OR “Scotland” OR “Wales” OR “England” OR “United States”[MeSH] OR “United Kingdom”[MeSH] OR Andorra OR Antigua OR Barbuda OR Aruba OR Australia OR Austria OR Bahamas OR Bahrain OR Barbados OR Belgium OR Bermuda OR Brunei OR Darussalam OR Canada OR “Cayman Islands” OR “Channel Islands” OR Chile OR Croatia OR Curacao OR Cyprus OR “Czech Republic” OR Denmark OR Estonia OR “Equatorial Guinea” OR “Faeroe Islands” OR Finland OR France OR “French Polynesia” OR Germany OR Greece OR Greenland OR Guam OR “Hong Kong” OR Iceland OR Ireland OR “Isle of Man” OR Israel OR Italy OR Japan OR Korea OR Kuwait OR Latvia OR Liechtenstein OR Lithuania OR Luxembourg OR Macao OR Malta OR Monaco OR Netherlands OR “New Caledonia” OR “New Zealand” OR “Northern Mariana Islands” OR Norway OR Oman OR Poland OR Portugal OR “Puerto Rico” OR Qatar OR “Russian Federation” OR Russia OR “San Marino” OR “Saudi Arabia” OR Singapore OR “Sint Maarten” OR “Saint Maarten” OR “St. Martin” OR “Saint Martin” OR “Slovak Republic” OR Slovenia OR Spain OR “St. Kitts” OR Nevis OR Sweden OR Switzerland OR Taiwan OR “Trinidad” OR “Tobago” OR Turks OR Caicos OR Uruguay OR “United Arab Emirates” or “U.S. Virgin Islands”

#5 (“2010/01/01″[PDat] : “2018/03/05″[PDat] ) AND English[lang])

#6 #1 AND #2 AND #3 AND #4 AND #5

Scopus

( TITLE-ABS-KEY ( school ) AND ( TITLE-ABS-KEY (pedestrian* or transport* or active or bike OR biker OR biking OR bicycle OR bicycling OR commute* OR commuting OR travel* OR cycling OR cyclist OR walk OR walked OR walking OR walks OR walkers ) AND (( TITLE-ABS-KEY (policy or policies OR preparation OR promotion* OR program* or “physical environment” OR pilot OR project OR planning or “built environment” or environment* OR evaluat* OR engineer* OR encourage* OR education or equity or enforcement or intervention* OR implement* OR change OR impact ) OR ( TITLE-ABS-KEY ( walk W/3 school ) OR TITLE-ABS-KEY ( safe W/3 routes W/3 school ) OR TITLE-ABS-KEY ( walking W/3 schoolbus ) OR TITLE-ABS-KEY ( wallking W/3 school W/3 bus ) ) AND (TITLE-ABS-KEY (“United Kingdom” OR “United States” OR “Scotland” OR “Wales” OR “England” OR “United States” OR “United Kingdom” OR Andorra OR Antigua OR Barbuda OR Aruba OR Australia OR Austria OR Bahamas OR Bahrain OR Barbados OR Belgium OR Bermuda OR Brunei OR Darussalam OR Canada OR “Cayman Islands” OR “Channel Islands” OR Chile OR Croatia OR Curacao OR Cyprus OR “Czech Republic” OR Denmark OR Estonia OR “Equatorial Guinea” OR “Faeroe Islands” OR Finland OR France OR “French Polynesia” OR Germany OR Greece OR Greenland OR Guam OR “Hong Kong” OR Iceland OR Ireland OR “Isle of Man” OR Israel OR Italy OR Japan OR Korea OR Kuwait OR Latvia OR Liechtenstein OR Lithuania OR Luxembourg OR Macao OR Malta OR Monaco OR Netherlands OR “New Caledonia” OR “New Zealand” OR “Northern Mariana Islands” OR Norway OR Oman OR Poland OR Portugal OR “Puerto Rico” OR Qatar OR “Russian Federation” OR Russia OR “San Marino” OR “Saudi Arabia” OR Singapore OR “Sint Maarten” OR “Saint Maarten” OR “St. Martin” OR “Saint Martin” OR “Slovak Republic” OR Slovenia OR Spain OR “St. Kitts” OR Nevis OR Sweden OR Switzerland OR Taiwan OR “Trinidad” OR “Tobago” OR Turks OR Caicos OR Uruguay OR “United Arab Emirates” or “U.S. Virgin Islands”) AND PUBYEAR > 2009 ) ) AND ( LIMIT-TO ( LANGUAGE , “English” ) )

Cochrane

#1 pedestrian* or transport* or active or walk or walks or walking or walked or walkers or bike OR bikers OR biking OR bicycl* OR cycling OR cyclist* OR commute* OR commuting OR travel*:ti,ab,kw.

#2 policy or policies or preparation or promotion* or program* or “physical environment” or pilot or project or planning or “built environment” or environment* or evaluat* or engineer* or encourage* or education or equity or enforcement or intervention* or implement* or change or impact or “walk to school” or “safe routes to school” or “walking schoolbus” or “walking school bus” or “walking school buses”:ti,ab,kw

#3 “United Kingdom” OR “United States” OR “Scotland” OR “Wales” OR “England” OR “United States” OR “United Kingdom” OR Andorra OR Antigua OR Barbuda OR Aruba OR Australia OR Austria OR Bahamas OR Bahrain OR Barbados OR Belgium OR Bermuda OR Brunei OR Darussalam OR Canada OR “Cayman Islands” OR “Channel Islands” OR Chile OR Croatia OR Curacao OR Cyprus OR “Czech Republic” OR Denmark OR Estonia OR “Equatorial Guinea” OR “Faeroe Islands” OR Finland OR France OR “French Polynesia” OR Germany OR Greece OR Greenland OR Guam OR “Hong Kong” OR Iceland OR Ireland OR “Isle of Man” OR Israel OR Italy OR Japan OR Korea OR Kuwait OR Latvia OR Liechtenstein OR Lithuania OR Luxembourg OR Macao OR Malta OR Monaco OR Netherlands OR “New Caledonia” OR “New Zealand” OR “Northern Mariana Islands” OR Norway OR Oman OR Poland OR Portugal OR “Puerto Rico” OR Qatar OR “Russian Federation” OR Russia OR “San Marino” OR “Saudi Arabia” OR Singapore OR “Sint Maarten” OR “Saint Maarten” OR “St. Martin” OR “Saint Martin” OR “Slovak Republic” OR Slovenia OR Spain OR “St. Kitts” OR Nevis OR Sweden OR Switzerland OR Taiwan OR “Trinidad” OR “Tobago” OR Turks OR Caicos OR Uruguay OR “United Arab Emirates” or “U.S. Virgin Islands”

#4 School:ti,ab,kw.

#5 #1 and #2 and #3 and #4

Limits – Publication Year from 2010 to 2018

NTL

(kw: pedestrian* OR kw:active OR kw:walk OR kw:walks OR kw:walked OR kw:walking OR kw: walkers OR kw:bike OR kw:bikers OR kw:biking OR kw:bicycle OR kw:bicycles OR kw:bicycling OR kw:cycle OR kw:cycling OR kw:cyclist OR kw:cyclists OR kw:commute OR kw:commuting OR kw:transport OR kw:travel or kw:travels or kw:traveling or kw:travelling) AND (kw: policy or kw: policies OR kw: preparation OR kw: promotion OR kw: program or kw:programs or kw:programming or kw: “physical environment” OR kw: pilot OR kw: project OR kw: planning or kw: “built environment” or kw: environment OR kw: evaluate or kw:evaluation OR kw: engineer or kw:engineered or kw:engineering OR kw: encourage OR kw: education or kw: equity or kw: enforcement or kw: intervention OR kw: implement OR kw: change OR kw: impact OR kw: “walk to school” OR kw: “safe routes to school” OR kw: “walking schoolbus” OR kw: “walking school bus” OR kw: “walking school buses”) AND kw:school

LIMITS:2010-2018, English

Economic Review

The search for effectiveness evidence described above (search period through March 2018) also identified economic evidence included in this review. An additional search focused on economic studies within PubMed, Scopus, Cochrane, National Technical Information Service (NTIS), and EconLit (search period 1990 July 12, 2018).

Search terms and strategies were adjusted for each database, based on controlled and uncontrolled vocabularies and software. Informal searches were also conducted for unpublished studies and reports from governments and non-government organizations using the Google and Google Scholar search engines. Finally, reference lists in included studies were screened and subject matter experts were consulted for additional studies that may have been missed.

Database: PubMed
Date Searched: 7/12/2018
Results: 334/334 unique

Search Strategy:

#1 (pedestrian* or transport* or active or walk*[title/abstract] or walk*[mesh] OR Bike OR bikers OR biking OR bicycle or bicycled or bicycles or bicycling OR cycling OR cyclist* OR commute* OR commuting OR OR travel*)

#2 (policy or policies OR preparation OR promotion* OR program* or “physical environment” OR pilot OR project OR planning or “built environment” or environment* OR evaluat* OR engineer* OR encourage* OR education or equity or enforcement or intervention* OR implement* OR change OR impact OR “walk to school” OR “safe routes to school” OR “walking schoolbus” OR “walking school bus” OR “walking school buses”)

#3 (“school”[Title/Abstract])

#4 “United Kingdom” OR “United States” OR “Scotland” OR “Wales” OR “England” OR “United States”[MeSH] OR “United Kingdom”[MeSH] OR Andorra OR Antigua OR Barbuda OR Aruba OR Australia OR Austria OR Bahamas OR Bahrain OR Barbados OR Belgium OR Bermuda OR Brunei OR Darussalam OR Canada OR “Cayman Islands” OR “Channel Islands” OR Chile OR Croatia OR Curacao OR Cyprus OR “Czech Republic” OR Denmark OR Estonia OR “Equatorial Guinea” OR “Faeroe Islands” OR Finland OR France OR “French Polynesia” OR Germany OR Greece OR Greenland OR Guam OR “Hong Kong” OR Iceland OR Ireland OR “Isle of Man” OR Israel OR Italy OR Japan OR Korea OR Kuwait OR Latvia OR Liechtenstein OR Lithuania OR Luxembourg OR Macao OR Malta OR Monaco OR Netherlands OR “New Caledonia” OR “New Zealand” OR “Northern Mariana Islands” OR Norway OR Oman OR Poland OR Portugal OR “Puerto Rico” OR Qatar OR “Russian Federation” OR Russia OR “San Marino” OR “Saudi Arabia” OR Singapore OR “Sint Maarten” OR “Saint Maarten” OR “St. Martin” OR “Saint Martin” OR “Slovak Republic” OR Slovenia OR Spain OR “St. Kitts” OR Nevis OR Sweden OR Switzerland OR Taiwan OR “Trinidad” OR “Tobago” OR Turks OR Caicos OR Uruguay OR “United Arab Emirates” or “U.S. Virgin Islands”

#5 (“1990/01/01″[PDat] : “2009/12/31″[PDat] ) AND English[lang])

#6 (cost* OR economic* OR financ* OR ROI OR investment*) OR ec[subheading]

#7 #1 AND #2 AND #3 AND #4 AND #5 AND #6

Database: Scopus
Date Searched: 7/12/2018
Results: 638/427 unique

Search Strategy:

TITLE-ABS-KEY(school) AND TITLE-ABS-KEY(pedestrian* or transport* or active or bike OR biker OR biking OR bicycle OR bicycling OR commute* OR commuting OR travel* OR cycling OR cyclist OR walk OR walked OR walking OR walks OR walkers ) AND TITLE-ABS-KEY (policy OR policies OR preparation OR promotion* OR program* OR “physical environment” OR pilot OR project OR planning OR “built environment” OR environment* OR evaluat* OR engineer* OR encourage* OR education OR equity OR enforcement OR intervention* OR implement* OR change OR impact OR (walk W/3 school) OR (safe W/3 routes W/3 school) OR (walking W/3 schoolbus ) OR (wallking W/3 school W/3 bus )) AND (TITLE-ABS-KEY (“United Kingdom” OR “United States” OR “Scotland” OR “Wales” OR “England” OR “United States” OR “United Kingdom” OR Andorra OR Antigua OR Barbuda OR Aruba OR Australia OR Austria OR Bahamas OR Bahrain OR Barbados OR Belgium OR Bermuda OR Brunei OR Darussalam OR Canada OR “Cayman Islands” OR “Channel Islands” OR Chile OR Croatia OR Curacao OR Cyprus OR “Czech Republic” OR Denmark OR Estonia OR “Equatorial Guinea” OR “Faeroe Islands” OR Finland OR France OR “French Polynesia” OR Germany OR Greece OR Greenland OR Guam OR “Hong Kong” OR Iceland OR Ireland OR “Isle of Man” OR Israel OR Italy OR Japan OR Korea OR Kuwait OR Latvia OR Liechtenstein OR Lithuania OR Luxembourg OR Macao OR Malta OR Monaco OR Netherlands OR “New Caledonia” OR “New Zealand” OR “Northern Mariana Islands” OR Norway OR Oman OR Poland OR Portugal OR “Puerto Rico” OR Qatar OR “Russian Federation” OR Russia OR “San Marino” OR “Saudi Arabia” OR Singapore OR “Sint Maarten” OR “Saint Maarten” OR “St. Martin” OR “Saint Martin” OR “Slovak Republic” OR Slovenia OR Spain OR “St. Kitts” OR Nevis OR Sweden OR Switzerland OR Taiwan OR “Trinidad” OR “Tobago” OR Turks OR Caicos OR Uruguay OR “United Arab Emirates” OR “U.S. Virgin Islands”)) AND TITLE-ABS-KEY(cost* OR economic* OR financ* OR ROI OR investment*) AND PUBYEAR < 2010 AND PUBYEAR AFT 1989

AND

(LIMIT-TO (LANGUAGE , “English” ))

Database: Cochrane
Date Searched: 6/16/2017
Results: 40/24 unique

Search Strategy:

#1 pedestrian* or transport* or active or walk or walks or walking or walked or walkers or bike OR bikers OR biking OR bicycl* OR cycling OR cyclist* OR commute* OR commuting OR travel*:ti,ab,kw.

#2 policy or policies or preparation or promotion* or program* or “physical environment” or pilot or project or planning or “built environment” or environment* or evaluat* or engineer* or encourage* or education or equity or enforcement or intervention* or implement* or change or impact or “walk to school” or “safe routes to school” or “walking schoolbus” or “walking school bus” or “walking school buses”:ti,ab,kw

#3 “United Kingdom” OR “United States” OR “Scotland” OR “Wales” OR “England” OR “United States” OR “United Kingdom” OR Andorra OR Antigua OR Barbuda OR Aruba OR Australia OR Austria OR Bahamas OR Bahrain OR Barbados OR Belgium OR Bermuda OR Brunei OR Darussalam OR Canada OR “Cayman Islands” OR “Channel Islands” OR Chile OR Croatia OR Curacao OR Cyprus OR “Czech Republic” OR Denmark OR Estonia OR “Equatorial Guinea” OR “Faeroe Islands” OR Finland OR France OR “French Polynesia” OR Germany OR Greece OR Greenland OR Guam OR “Hong Kong” OR Iceland OR Ireland OR “Isle of Man” OR Israel OR Italy OR Japan OR Korea OR Kuwait OR Latvia OR Liechtenstein OR Lithuania OR Luxembourg OR Macao OR Malta OR Monaco OR Netherlands OR “New Caledonia” OR “New Zealand” OR “Northern Mariana Islands” OR Norway OR Oman OR Poland OR Portugal OR “Puerto Rico” OR Qatar OR “Russian Federation” OR Russia OR “San Marino” OR “Saudi Arabia” OR Singapore OR “Sint Maarten” OR “Saint Maarten” OR “St. Martin” OR “Saint Martin” OR “Slovak Republic” OR Slovenia OR Spain OR “St. Kitts” OR Nevis OR Sweden OR Switzerland OR Taiwan OR “Trinidad” OR “Tobago” OR Turks OR Caicos OR Uruguay OR “United Arab Emirates” or “U.S. Virgin Islands”

#4 School:ti,ab,kw

#5 (cost* OR economic* OR financ* OR ROI OR investment*):ti,ab,kw

#6 #1 and #2 and #3 and #4 AND #5 Limits – Publication Year from 1990 to 2018

Database: EconLit
Date Searched: 7/12/2018
Results: 693/685 unique

Search Strategy:

(TX pedestrian* or transport* or active or walk or walks or walking or walked or walkers or bike OR bikers OR biking OR bicycl* OR cycling OR cyclist* OR commute* OR commuting OR travel*)

AND

(TX policy or policies or preparation or promotion* or program* or “physical environment” or pilot or project or planning or “built environment” or environment* or evaluat* or engineer* or encourage* or education or equity or enforcement or intervention* or implement* or change or impact or “walk to school” or “safe routes to school” or “walking schoolbus” or “walking school bus” or “walking school buses”)

AND

(TX “United Kingdom” OR “United States” OR “Scotland” OR “Wales” OR “England” OR “United States” OR “United Kingdom” OR Andorra OR Antigua OR Barbuda OR Aruba OR Australia OR Austria OR Bahamas OR Bahrain OR Barbados OR Belgium OR Bermuda OR Brunei OR Darussalam OR Canada OR “Cayman Islands” OR “Channel Islands” OR Chile OR Croatia OR Curacao OR Cyprus OR “Czech Republic” OR Denmark OR Estonia OR “Equatorial Guinea” OR “Faeroe Islands” OR Finland OR France OR “French Polynesia” OR Germany OR Greece OR Greenland OR Guam OR “Hong Kong” OR Iceland OR Ireland OR “Isle of Man” OR Israel OR Italy OR Japan OR Korea OR Kuwait OR Latvia OR Liechtenstein OR Lithuania OR Luxembourg OR Macao OR Malta OR Monaco OR Netherlands OR “New Caledonia” OR “New Zealand” OR “Northern Mariana Islands” OR Norway OR Oman OR Poland OR Portugal OR “Puerto Rico” OR Qatar OR “Russian Federation” OR Russia OR “San Marino” OR “Saudi Arabia” OR Singapore OR “Sint Maarten” OR “Saint Maarten” OR “St. Martin” OR “Saint Martin” OR “Slovak Republic” OR Slovenia OR Spain OR “St. Kitts” OR Nevis OR Sweden OR Switzerland OR Taiwan OR “Trinidad” OR “Tobago” OR Turks OR Caicos OR Uruguay OR “United Arab Emirates” or “U.S. Virgin Islands”)

AND

(TI School) OR (AB School)

AND

(TX cost* OR economic* OR financ* OR ROI OR investment*)

LIMITS: English

Database: NTIS
Date Searched: 7/12/2018
Results: 274/274 unique

Search Strategy:

(TX pedestrian* or transport* or active or walk or walks or walking or walked or walkers or bike OR bikers OR biking OR bicycl* OR cycling OR cyclist* OR commute* OR commuting OR travel*)

AND

(TX policy or policies or preparation or promotion* or program* or “physical environment” or pilot or project or planning or “built environment” or environment* or evaluat* or engineer* or encourage* or education or equity or enforcement or intervention* or implement* or change or impact or “walk to school” or “safe routes to school” or “walking schoolbus” or “walking school bus” or “walking school buses”)

AND

(TI School*) OR (AB School*)

AND

(TX cost* OR economic* OR financ* OR ROI OR investment*)

LIMITS:1990-2009, English

Chill n P, Evenson KR, Vaughn A, et al. A systematic review of intervention ns for promoting active transportation to school. International Journal of Behavioral Nutrition and Physical Activity 2011;8(1):10.

U.S. Department of Health and Human Services. Physical Activity Guidelines Advisory Committee report. Washington (DC): U.S. Department of Health and Human Services; 2008a.

U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Washington (DC): U.S. Department of Health and Human Services; 2008b.

U.S. Department of Health and Human Services, Physical Activity Guidelines Advisory Committee. Physical activity guidelines advisory committee scientific report. Washington (DC): U.S. U.S. Department of Health and Human Services; 2018a.

U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department of Health and Human Services; 2018b.

The following considerations for implementation are drawn from studies included in the evidence review, the broader literature, and expert opinion.

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

• These programs emphasize selecting and modifying intervention components to address school and neighborhood-specific barriers to active travel. Implementation guidance is available online:
  • Safe Routes to School National Partnership
  • National Center for Safe Routes to School
• Additional implementation guidance and technical assistance may be available from state and local Safe Routes to School programs.

Safe Routes to School provides additional resources to help communities address particular barriers to program implementation or participation:

• Using Safe Routes to School to Combat The Threat Of Violence
• Implementing Safe Routes to School in Low-Income Schools and Communities
• On the Move: Safe Routes to School Policies in Rural School Districts
• Rural Communities: A Two Pronged Approach for Improving Walking and Bicycling
• Engaging Students with Disabilities in Safe Routes to School

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.

Healthy People 2030

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

• Increase the proportion of adolescents who walk or bike to get places — PA‑11