Implementation of a walking school bus: lessons learned

A Tale of Two Cities: Unpacking the Success and Failure of School Street Interventions in Two Canadian Cities

One innovative strategy to support child-friendly cities is street-based interventions that provide safe, vehicle-free spaces for children to play and move about freely. School streets are one such innovation involving closing streets around elementary schools to vehicular traffic to improve children's safety as they come and go from school while providing opportunities for children to play and socialize on the street. Launching these initiatives in communities dominated by automobiles is enormously challenging and little is known about why these interventions are successfully launched in some places but not others. As part of a larger research project called Levelling the Playing Fields, two School Street initiatives were planned for the 2021-2022 school year; one initiative was successfully launched in Kingston, ON, while the second initiative failed to launch in Montreal, QC. Using a critical realist evaluation methodology, this paper documents the contextual elements and key mechanisms that enabled and constrained the launch of these School Streets in these cities, through document analysis and key informant interviews. Our results suggest that municipal and school support for the initiative are both imperative to establishing legitimacy and collaborative governance, both of which were necessary for a successful launch.

Implementation of School Remote Drop-off Walking Programs: Results from Qualitative Interviews

BACKGROUND

Remote drop-off programs allow children living "unwalkable" distances from school to walk partway by being dropped off by personal vehicle or bus closer to the school, supporting physical activity and health. However, little evidence exists to guide implementation of such programs.

METHODS

Semi-structured interviews were conducted with key informants from 7 remote drop-off programs to capture descriptive information and qualitative content (e.g., barriers, facilitators, outcomes). Qualitative content was analyzed using inductive thematic analysis and identified themes were organized within implementation science frameworks.

RESULTS

Programs were from low and high socioeconomic areas (free/reduced price lunch range=4%-92%) and initiated by various champions (school staff=29%, parents=29%, external=42%). 29% of programs incorporated the yellow school bus, 43% involved >100 students, and 71% involved route distances ≥0.5 miles. Twenty themes were identified across 5 implementation science domains (Intervention Characteristics, Inner Setting, Outer Setting, Implementation Process, and Outcomes). Positive outcomes included physical activity, socialization, and improved focus for students; decreased traffic; and positive perceptions of the program by students, parents, and school staff/administrators. Barriers included traffic, weather, and student engagement. Facilitators included having a champion and support from school leaders and the community, conducting process improvements, and incentivizing participation.

CONCLUSIONS

Remote drop-offs are feasible for supporting active school commuting but underutilized. Promising strategies for supporting uptake and implementation of such programs include communicating benefits, developing champions, engaging school and community leaders, and improving the neighborhood built environment.

Implementation contextual factors related to community-based active travel to school interventions: a mixed methods interview study

Background

Active travel to school contributes to multiple physical and psychosocial benefits for youth, yet population rates of active travel to school are alarmingly low in the USA and many other countries. Though walking school bus interventions are effective for increasing rates of active travel to school and children’s overall physical activity, uptake of such interventions has been low. The objective of this study was to conduct a mixed methods implementation evaluation to identify contextual factors that serve as barriers and facilitators among existing walking school bus programs.

Methods

Semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR) were conducted with leaders of low-sustainability (n = 9) and high-sustainability (n = 11) programs across the USA. A combination of quantitative (CFIR-based) coding and inductive thematic analysis was used. The CFIR-based ratings were compared between the low- and high-sustainability programs and themes, subthemes, and exemplary quotes were provided to summarize the thematic analysis.

Results

In both the low- and high-sustainability programs, three of the 15 constructs assessed were commonly rated as positive (i.e., favorable for supporting implementation): student/family needs and resources, implementation climate, and planning. Three constructs were more often rated as positive in the high-sustainability programs: organizational incentives and rewards, engaging students and parents, and reflecting and evaluating. Three constructs were more often rated as positive in the low-sustainability programs: student/family needs and resources - built environment, available resources, and access to knowledge and information. Four themes emerged from the thematic analysis: planning considerations, ongoing coordination considerations, resources and supports, and benefits.

Conclusions

Engagement of students, parents, and community members were among the factors that emerged across the quantitative and qualitative analyses as most critical for supporting walking school bus program implementation. The information provided by program leaders can help in the selection of implementation strategies that overcome known barriers for increasing the long-term success of community-based physical activity interventions such as the walking school bus.

Walking School Bus Programs: Implementation Factors, Implementation Outcomes, and Student Outcomes, 2017-2018

PURPOSE AND OBJECTIVES

Walking school bus programs increase children's physical activity through active travel to school; however, research to inform large-scale implementation of such programs is limited. We investigated contextual factors, implementation outcomes, and student outcomes in existing walking school bus programs in the United States and internationally.

INTERVENTION APPROACH

Walking school bus programs involve a group of children walking to school together with an adult leader. On the trip to school, these adults provide social support, address potential traffic and interpersonal safety, and serve as role models to the children while children increase their physical activity levels.

EVALUATION METHODS

We conducted surveys with existing walking school bus programs identified through internet searches, referrals, and relevant email listservs. Leaders from 184 programs that operated at least 1 trip per week completed the survey. We used regression analyses to compare differences in contextual factors by area income and location, associations between contextual factors and implementation outcomes, and associations between implementation outcomes and student outcomes.

RESULTS

Walking school bus programs in low-income communities had more route leaders and engaged in more active travel to school-related activities of being sustained than those in higher income. Programs that had no external funding, multiple route leaders, and coordination by a school or district staff member (as opposed to a parent) had greater student participation than other programs. Providing more trips than other programs per week was associated with reduced tardiness, reduced bullying, and improved neighborhood walkability. The greatest barriers to implementation were recruiting and maintaining students and identifying and maintaining route leaders.

IMPLICATIONS FOR PUBLIC HEALTH

Walking school bus programs can be implemented successfully in many contexts using various models. The involvement of several people in leadership roles is critical for sustainability. Evidence-based implementation strategies that overcome barriers can improve reach, implementation, and sustainability of walking school bus programs and can increase children's physical activity.

Parent Perceptions on a Walking School Bus Program Among Low-Income Families: A Qualitative Study

BACKGROUND

The walking school bus (WSB) is a promising intervention to increase walking to school and physical activity in school-age children. The aim of this qualitative study was to assess parent perceptions of a WSB program that was part of a randomized controlled trial to inform future programs.

METHODS

The authors interviewed 45 parents whose children had participated in a WSB program in the Seattle area, in which third- and fifth-grade students walked to/from school with adult chaperones along a set route. The authors performed a qualitative analysis of the interview transcripts and coded interview segments into 4 broad categories as follows: facilitators, barriers, general positive sentiments, and proposals.

RESULTS

Most parents spoke of the benefits of the WSB program; in particular, parents frequently applauded exercise/physical health benefits. Of the barriers, the most frequently cited was time, with work schedule and commute changes leading some families to walk less frequently.

CONCLUSIONS

Most parents voiced support for the WSB program as a means to improve child health, to learn pedestrian safety, and to interact with positive adult role models. Parents made several suggestions to improve the program, including better recruitment methods, logistical improvements, and a platform for communicating with other parents.

Impact of an Australian state-wide active travel campaign targeting primary schools

Active travel can have health and environmental benefits. This study evaluated the impact of a month-long (October 2015) campaign encouraging primary school children in Victoria, Australia to engage in active school travel. With support from local councils, schools participated in the campaign by monitoring active school travel and delivering promotional activities. A longitudinal study evaluated campaign impact. Carers (n = 715) of Victorian primary school children were recruited via social media and completed online surveys at baseline (T1; 0 wk) and during (T2; +2 wks) and after the campaign (T3; +6 wks). Carers reported their child's travel behaviour over the last five school days, and whether their child and/or their child's school participated in the campaign. Separate generalised linear models were used for T2 and T3 outcomes adjusting for T1 values and potential confounders. A greater proportion of children who participated in the campaign engaged in any active school travel at T2 (OR = 2.49, 95% CI = 1.63, 3.79) and T3 (1.62, 95% CI = 1.06, 2.46) compared with non-participating children. Similarly, these children had a higher frequency of active school travel at T2 (IRR = 1.60, 95% CI = 1.29, 1.97) and T3 (IRR = 1.45, 95% CI = 1.16, 1.80). Campaign participation resulted in small, short-term increases in active school travel.

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A controlled trial evaluated a state-wide campaign to promote school active travel.

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Carers reported school active travel at baseline and after the four-week campaign.

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A greater proportion of participating children engaged in school active travel.

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Campaign impact did not differ by key individual and area-level indicators.

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However, campaign impact did differ by sex and distance to school.

Active Commuting to School, Physical Activity, and Behavior Problems Among Third-Grade Children

BACKGROUND

We examined factors associated with active commuting to school and the relationships of active commuting and physical activity to child- and teacher-reported internalizing and externalizing behavior problems in a sample of third graders.

METHODS

The study sample consisted of 13,166 third graders enrolled in the Early Childhood Longitudinal Study Kindergarten Class of 1998-1999. "Active" commuters were children who walked to school and "passive" commuters were those who took the bus or were driven. Linear analyses evaluated differences in behavior problems by school commute, physical activity, and sports team participation after adjusting for sociodemographic, regional, and neighborhood factors.

RESULTS

Overall, 11% of children actively commuted. Type of commute differed by sociodemographics, region, urbanicity, school type, and neighborhood safety. Active commuters had less general physical activity participation and sports team participation. Commuting type and general physical activity were not associated with behavior problems, but sports team participation was associated with fewer child-reported internalizing and externalizing behaviors as well as fewer teacher-reported internalizing behaviors.

CONCLUSIONS

Our findings demonstrate the ongoing need for creating and maintaining physical activity programs (such as sports teams) among school-aged children to optimize children's overall health and well-being.

From sedentary to active school commute: Multi-level factors associated with travel mode shifts

Previous research has examined personal, social, and environmental correlates of active commuting to school, but most were cross-sectional and mode choice studies. This exploratory case study utilized a retrospective natural experiment opportunity, where a group of students transferred to a new school, and therefore experienced changes in their home-to-school travel environments. It examined whether such changes led to mode shifts from sedentary (car or school bus) to active (walking and bicycling) and what factors were associated with those shifts. Retrospective parental survey data (n=165, response rate=46%) were collected in 2011 from a new elementary school that opened in 2010 in Austin, Texas. The survey asked about the child's school travel mode and parental perceptions of home-to-school travel environments before and after the transfer, as well as personal and social factors. Multivariate logistic regressions were used to predict the odds of shifting from sedentary to active modes, using personal, social, and physical environmental variables. Sixty-eight (41.2%) respondents reported a sedentary-to-active mode shift for school commuting. Such shifts were associated with changes in school travel environments (e.g., shorter travel distance, improved safety, and decreased availability of bike lanes/paths) and relevant programs/services (e.g., increase in walking-promotion programs, and decrease in school bus service due to shortened distances). Targeting the current sedentary mode users is important to bring health benefits through increased physical activity and environmental benefits from reduced automobile use. Sedentary-to-active mode shifts may be encouraged by providing walking-promotion programs and by reducing travel distances and safety threats en route to school.

Economic Preferences and Obesity among a Low-Income African American Community

Obesity has reached epidemic proportions in the US, with a significantly higher fraction of African Americans who are obese than whites. Yet there is little understanding of why some individuals become obese while others do not. We conduct a lab-in-field experiment in a low-income African American community to investigate whether risk and time preferences play a role in the tendency to become obese. We examine the relationship between incentivized measures of risk and time preferences and weight status (BMI), and find that individuals who are more tolerant of risk are more likely to have a higher BMI. This result is driven by the most risk tolerant individuals. Patience is not independently statistically related to BMI in this sample, but those who are more risk averse and patient are less likely to be obese.

Active transportation to support diabetes prevention: Expanding school health promotion programming in an Indigenous community

BACKGROUND

School-based physical activity (PA) interventions, including school active transportation (AT), provide opportunities to increase daily PA levels, improves fitness, and reduces risk of diseases, such as type 2 diabetes. Based on a community-identified need, the Kahnawake Schools Diabetes Prevention Project, within an Indigenous community, undertook school travel planning to contribute to PA programming for two elementary schools.

METHODS

Using community-based participatory research, the Active & Safe Routes to School's School Travel Planning (STP) process was undertaken in two schools with an STP-Committee comprised of community stakeholders and researchers. STP activities were adapted for local context including: school profile form, family survey, in-class travel survey, pedestrian-traffic observations, walkability checklist, and student mapping.

RESULTS

STP data were jointly collected, analyzed and interpreted by researchers and community. Traffic-pedestrian observations, walkability and parent surveys identified key pedestrian-traffic locations, helped develop safe/direct routes, and traffic calming strategies. In-class travel and mapping surveys identified a need and student desire to increase school AT. The STP-Committee translated findings into STP-action plans for two schools, which were implemented in 2014-2015 school year.

CONCLUSIONS

Combining CBPR with STP merges community and researcher expertise. This project offered evidence-informed practice for active living promotions. Experience and findings could benefit Indigenous and non-Indigenous communities.

Searching for rigour in the reporting of mixed methods population health research: a methodological review

The environments in which population health interventions occur shape both their implementation and outcomes. Hence, when evaluating these interventions, we must explore both intervention content and context. Mixed methods (integrating quantitative and qualitative methods) provide this opportunity. However, although criteria exist for establishing rigour in quantitative and qualitative research, there is poor consensus regarding rigour in mixed methods. Using the empirical example of school-based obesity interventions, this methodological review examined how mixed methods have been used and reported, and how rigour has been addressed. Twenty-three peer-reviewed mixed methods studies were identified through a systematic search of five databases and appraised using the guidelines for Good Reporting of a Mixed Methods Study. In general, more detailed description of data collection and analysis, integration, inferences and justifying the use of mixed methods is needed. Additionally, improved reporting of methodological rigour is required. This review calls for increased discussion of practical techniques for establishing rigour in mixed methods research, beyond those for quantitative and qualitative criteria individually. A guide for reporting mixed methods research in population health should be developed to improve the reporting quality of mixed methods studies. Through improved reporting, mixed methods can provide strong evidence to inform policy and practice.

Expanding a successful community-based obesity prevention approach into new communities: Challenges and achievements

OBJECTIVE

A previously successful community-based obesity prevention intervention with a focus on school settings was expanded into new communities with varying contexts. In order to understand the complexities involved in implementing health promotion activities in schools, this study examined experiences of school staff and project officers including barriers, contextual factors and achievements.

METHODS

School environment assessments were conducted in schools across four Victorian communities with school staff (n=1-5 staff plus a trained researcher per group in 9 primary and 8 secondary schools) 12-18 months post-intervention. Process reports from project officers were also reviewed and analysed (n=4).

RESULTS

School staff commonly reported time pressures as a barrier to implementation and project officers working within schools reported competing priorities and limited health promotion experience of staff; lack of stakeholder engagement; low participation in some activities and insufficient implementation time. Contextual factors included community socioeconomic status, student ethnicity and living rurally. Achievements included student and staff enjoyment from programme activities, staff capacity building, partnerships, embedding activities into existing infrastructure and programmes, and having consistent health-related messages repeated through a variety of strategies.

CONCLUSIONS

Community-based interventions with a focus on school settings need to consider system level, organisational and contextual (i.e. socioeconomic, ethnicity, family and town characteristics) factors when expanding previously effective strategies into new communities. Implementation benefits may have added whole of school benefits in addition to child health. Focussing on overcoming the challenges experienced in this complex initiative is required for future interventions.

TRIAL REGISTRATION

ACTRN12609000892213.

Walking school buses as a form of active transportation for children-a review of the evidence

BACKGROUND

Walking school buses (WSBs) offer a potentially healthier way for children to get to school while reducing traffic congestion. A number of pressing societal challenges make it timely to evaluate evidence of their value.

METHODS

Studies that focused solely on WSBs were identified through online and manual literature searches. Twelve WSB studies involving a total of 9169 children were reviewed. Study aims, designs, methods, outcomes, and barriers and facilitators were examined.

RESULTS

WSBs were found to be associated with increased prevalence of walking to school and general activity levels although not always significantly. Time constraints emerged as barriers to WSBs, impacting on recruitment of volunteers and children to the WSBs. Facilitators of WSBs included children enjoying socializing and interacting with the environment.

CONCLUSIONS

Preliminary evidence of the health value of WSBs was demonstrated, along with recommendations for the design of future studies. By tackling barriers of time constraints, volunteer recruitment, and parents' safety concerns while at the same time, increasing convenience and time savings for families, future WSBs are likely to be more sustainable and taken up by more schools. Implications for future innovation in school health were identified.

Effectiveness of a child's fable on the cognition of preschools when used to address childhood obesity

The study investigated the effectiveness of a child's fable on the cognition of preschoolers when used to address childhood obesity. A single group, pretest/posttest design was used with 57 preschool children. Analysis of variance compared pre-existing differences between the four classes with respect to pre-test scores. A repeated measures t-test analyzed changes in scores as a result of the intervention. Following the fable intervention, students showed a significant difference (0.5) between their pre- and post-test scores, indicating this method to an effective learning strategy in this setting and age population.

Feasibility and effectiveness of drop-off spots to promote walking to school

Background

Drop-off spots are locations in the proximity of primary schools where parents can drop off or pick up their child. From these drop-off spots children can walk to and from school. This pilot study aimed to investigate the feasibility and effectiveness of drop-off spots and to evaluate how drop-off spots are perceived by school principals, teachers and parents of 6-to-12-year old children.

Methods

First, a feasibility questionnaire was completed (n = 216) to obtain parental opinions towards the implementation of drop-off spots. A drop-off spot was organized (500–800 m distance from school) in two primary schools. A within-subject design was used to compare children’s (n = 58) step counts and number of walking trips during usual conditions (baseline) and during implementation of a drop-off spot (intervention). Three-level (class-participant-condition) linear regression models were used to determine intervention effects. After the intervention, 2 school principals, 7 teachers and 44 parents filled out a process evaluation questionnaire.

Results

Prior to the intervention, 96% expressed the need for adult supervision during the route to school. Positive significant intervention effects were found for step counts before/after school hours (+732 step counts/day; X² = 12.2; p < 0.001) and number of walking trips to/from school (+2 trips/week; X² = 52.9; p < 0.001). No intervention effect was found for total step counts/day (X² = 2.0; p = 0.16). The intervention was positively perceived by the school principals and parents, but teachers expressed doubts regarding future implementation.

Conclusion

This pilot study showed that implementing drop-off spots might be an effective intervention to promote children’s walking to school. Implementing drop-off spots does not require major efforts from the schools and schools can choose how and when they organize drop-off spots. However, motivating teachers and involving other volunteers (e.g. parents, grandparents) may be needed. Future studies should investigate the feasibility and effectiveness of drop-off spots in a larger sample of schools.

Parental factors in children's active transport to school

OBJECTIVE

Identify non-distance factors related to children's active transport (AT) to school, including parental, home, and environment characteristics. Understanding the factors related to children's AT to school, beyond distance to school, could inform interventions to increase AT and children's overall physical activity.

STUDY DESIGN

Participants were in the Neighborhood Impact on Kids Study, a longitudinal, observational cohort study of children aged 6-11 and their parents in King County, WA and San Diego County, CA between 2007 and 2009. Parents reported frequency and mode of child transport to school, perceived neighbourhood, home and family environments, parental travel behaviours, and sociodemographics.

METHODS

Children living less than a 20 minute walk to school were in this analysis. Children classified as active transporters (walked/bicycled to or from school at least once per week) were compared with those not using AT as often.

RESULTS

Children using AT were older and had parents who reported themselves using active transport. Having a family rule that restricts the child to stay within sight of the parent or home and more parent working hours were related to lower odds of a child using AT.

CONCLUSIONS

Children's AT to school is associated with parental AT to work and other locations. Interventions should be considered that enable whole family AT, ameliorate safety concerns and decrease the need for parental supervision, such as walking school buses.

Examining the impact of the walking school bus with an agent-based model

We used an agent-based model to examine the impact of the walking school bus (WSB) on children's active travel to school. We identified a synergistic effect of the WSB with other intervention components such as an educational campaign designed to improve attitudes toward active travel to school. Results suggest that to maximize active travel to school, children should arrive on time at "bus stops" to allow faster WSB walking speeds. We also illustrate how an agent-based model can be used to identify the location of routes maximizing the effects of the WSB on active travel. Agent-based models can be used to examine plausible effects of the WSB on active travel to school under various conditions and to identify ways of implementing the WSB that maximize its effectiveness.

Health behavior and behavioral economics: economic preferences and physical activity stages of change in a low-income African-American community

PURPOSE

To examine the relationship between physical activity stages of change and preferences for financial risk and time.

DESIGN

A cross-sectional, community-based study.

SETTING

A low-income, urban, African-American neighborhood.

SUBJECTS

One hundred sixty-nine adults.

MEASURES

Self-reported physical activity stages of change-precontemplation to maintenance, objectively measured body mass index and waist circumference, and economic preferences for time and risk measured via incentivized economic experiments.

ANALYSIS

Multivariable ordered logistic regression models were used to examine the association between physical activity stages of change and economic preferences while controlling for demographic characteristics of the individuals.

RESULTS

Individuals who are more tolerant of financial risks (odds ratio [OR] = 1.31, p < .05) and whose time preferences indicate more patience (OR = 1.68, p < .01) are more likely to be in a more advanced physical activity stage (e.g., from preparation to action). The likelihood of being in the maintenance stage increases by 5.6 and 10.9 percentage points for each one-unit increase in financial risk tolerance or one-unit increase in the time preference measure, respectively.

CONCLUSION

Greater tolerance of financial risk and more patient time preferences among this low-income ethnic minority population are associated with a more advanced physical activity stage. Further exploration is clearly warranted in larger and more representative samples.

Culturally competent interventions to address obesity among African American and Latino children and youth

While obesity impacts all ethnic groups in the United States, African Americans and Latinos are particularly at high risk for obesity. The purpose of this paper is to provide an analysis of the literature on evidence-based culturally competent strategies for addressing and preventing obesity and discuss roles for occupational therapists working with populations at risk for obesity in the school or therapeutic clinical environment. A review was conducted of over 80 research articles describing successful interventions conducted in schools and communities targeting African Americans and Latino children. Although unique single strategies are highlighted in this paper, obesity interventions are complex and involved a number of multilevel strategies. The results of the analysis of the literature are presented according to strategies that promote healthy eating, physical activity, and overall healthy lifestyles. Along with the cultural competent strategies, we recommend specific roles for occupational therapists in order to promote the implementation of each particular strategy. Lastly, implications for occupational therapy are discussed.

School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18

BACKGROUND

The World Health Organization (WHO) estimates that 1.9 million deaths worldwide are attributable to physical inactivity and at least 2.6 million deaths are a result of being overweight or obese. In addition, WHO estimates that physical inactivity causes 10% to 16% of cases each of breast cancer, colon, and rectal cancers as well as type 2 diabetes, and 22% of coronary heart disease and the burden of these and other chronic diseases has rapidly increased in recent decades.

OBJECTIVES

The purpose of this systematic review was to summarize the evidence of the effectiveness of school-based interventions in promoting physical activity and fitness in children and adolescents.

SEARCH METHODS

The search strategy included searching several databases to October 2011. In addition, reference lists of included articles and background papers were reviewed for potentially relevant studies, as well as references from relevant Cochrane reviews. Primary authors of included studies were contacted as needed for additional information.

SELECTION CRITERIA

To be included, the intervention had to be relevant to public health practice (focused on health promotion activities), not conducted by physicians, implemented, facilitated, or promoted by staff in local public health units, implemented in a school setting and aimed at increasing physical activity, included all school-attending children, and be implemented for a minimum of 12 weeks. In addition, the review was limited to randomized controlled trials and those that reported on outcomes for children and adolescents (aged 6 to 18 years). Primary outcomes included: rates of moderate to vigorous physical activity during the school day, time engaged in moderate to vigorous physical activity during the school day, and time spent watching television. Secondary outcomes related to physical health status measures including: systolic and diastolic blood pressure, blood cholesterol, body mass index (BMI), maximal oxygen uptake (VO2max), and pulse rate.

DATA COLLECTION AND ANALYSIS

Standardized tools were used by two independent reviewers to assess each study for relevance and for data extraction. In addition, each study was assessed for risk of bias as specified in the Cochrane Handbook for Systematic Reviews of Interventions. Where discrepancies existed, discussion occurred until consensus was reached. The results were summarized narratively due to wide variations in the populations, interventions evaluated, and outcomes measured.

MAIN RESULTS

In the original review, 13,841 records were identified and screened, 302 studies were assessed for eligibility, and 26 studies were included in the review. There was some evidence that school-based physical activity interventions had a positive impact on four of the nine outcome measures. Specifically positive effects were observed for duration of physical activity, television viewing, VO2 max, and blood cholesterol. Generally, school-based interventions had little effect on physical activity rates, systolic and diastolic blood pressure, BMI, and pulse rate. At a minimum, a combination of printed educational materials and changes to the school curriculum that promote physical activity resulted in positive effects.In this update, given the addition of three new inclusion criteria (randomized design, all school-attending children invited to participate, minimum 12-week intervention) 12 of the original 26 studies were excluded. In addition, studies published between July 2007 and October 2011 evaluating the effectiveness of school-based physical interventions were identified and if relevant included. In total an additional 2378 titles were screened of which 285 unique studies were deemed potentially relevant. Of those 30 met all relevance criteria and have been included in this update. This update includes 44 studies and represents complete data for 36,593 study participants. Duration of interventions ranged from 12 weeks to six years.Generally, the majority of studies included in this update, despite being randomized controlled trials, are, at a minimum, at moderate risk of bias. The results therefore must be interpreted with caution. Few changes in outcomes were observed in this update with the exception of blood cholesterol and physical activity rates. For example blood cholesterol was no longer positively impacted upon by school-based physical activity interventions. However, there was some evidence to suggest that school-based physical activity interventions led to an improvement in the proportion of children who engaged in moderate to vigorous physical activity during school hours (odds ratio (OR) 2.74, 95% confidence interval (CI), 2.01 to 3.75). Improvements in physical activity rates were not observed in the original review. Children and adolescents exposed to the intervention also spent more time engaged in moderate to vigorous physical activity (with results across studies ranging from five to 45 min more), spent less time watching television (results range from five to 60 min less per day), and had improved VO2max (results across studies ranged from 1.6 to 3.7 mL/kg per min). However, the overall conclusions of this update do not differ significantly from those reported in the original review.

AUTHORS' CONCLUSIONS

The evidence suggests the ongoing implementation of school-based physical activity interventions at this time, given the positive effects on behavior and one physical health status measure. However, given these studies are at a minimum of moderate risk of bias, and the magnitude of effect is generally small, these results should be interpreted cautiously. Additional research on the long-term impact of these interventions is needed.

Understanding the drive to escort: a cross-sectional analysis examining parental attitudes towards children's school travel and independent mobility

BACKGROUND

The declining prevalence of Active School Transportation (AST) has been accompanied by a decrease in independent mobility internationally. The objective of this study was to compare family demographics and AST related perceptions of parents who let their children walk unescorted to/from school to those parents who escort (walk and drive) their children to/from school. By comparing these groups, insight was gained into how we may encourage greater AST and independent mobility in youth living in the Greater Toronto and Hamilton Area, Canada.

METHODS

This study involved a cross-sectional design, using data from a self-reported questionnaire (n =1,016) that examined parental perceptions and attitudes regarding AST. A multinomial logistic regression analysis was used to explore the differences between households where children travelled independently to school or were escorted.

RESULTS

Findings revealed that unescorted children were: significantly older, the families spoke predominantly English at home, more likely to live within one kilometer from school, and their parents agreed to a greater extent that they chose to reside in the current neighborhood in order for their child to walk to/from school. The parents of the escorted children worried significantly more about strangers and bullies approaching their child as well as the traffic volume around school.

CONCLUSIONS

From both a policy and research perspective, this study highlights the value of distinguishing between mode (i.e., walking or driving) and travel independence. For policy, our findings highlight the need for planning decisions about the siting of elementary schools to include considerations of the impact of catchment size on how children get to/from school. Given the importance of age, distance, and safety issues as significant correlates of independent mobility, research and practice should focus on the development and sustainability of non-infrastructure programs that alleviate parental safety concerns.

Camp SHINE

According to the National Health and Nutritional Examination Survey (NHANES), in 2008, more than one third of children and adolescents were overweight or obese. This article describes the use of a residential, medically supervised summer camp to help overweight and obese children prevent excessive summertime weight gain. The theoretical framework guiding the program was Rosenstock’s health belief model (HBM). The weight loss results are included as well as information concerning adaptations of physical activities, environmental design considerations, and creating a supportive atmosphere, to meet the unique needs of this population. Data show that weight loss can be achieved for overweight/obese children/teens in residential camps designed to develop healthy behaviors.

A systematic review of interventions for promoting active transportation to school

BACKGROUND

Active transportation to school is an important contributor to the total physical activity of children and adolescents. However, active school travel has declined over time, and interventions are needed to reverse this trend. The purpose of this paper is to review intervention studies related to active school transportation to guide future intervention research.

METHODS

A systematic review was conducted to identify intervention studies of active transportation to school published in the scientific literature through January 2010. Five electronic databases and a manual search were conducted. Detailed information was extracted, including a quantitative assessment comparing the effect sizes, and a qualitative assessment using an established evaluation tool.

RESULTS

We identified 14 interventions that focused on active transportation to school. These interventions mainly focused on primary school children in the United States, Australia, and the United Kingdom. Almost all the interventions used quasi-experimental designs (10/14), and most of the interventions reported a small effect size on active transportation (6/14).

CONCLUSION

More research with higher quality study designs and measures should be conducted to further evaluate interventions and to determine the most successful strategies for increasing active transportation to school.

Parental factors associated with walking to school and participation in organised activities at age 5: analysis of the Millennium Cohort Study

Background

Physical activity is associated with better health. Two sources of activity for children are walking to school and taking part in organised sports and activities. This study uses a large national cohort to examine factors associated with participation in these activities.

Methods

The Millennium Cohort study contains 5 year follow-up of 17,561 singleton children recruited between 2000-2002 in the UK. All participants were interviewed in their own homes at 9 months, 3 years and 5 years follow-up and all measures were self reports. Logistic regression and likelihood ratio tests were used.

Results

Children are less likely to walk to school as income and parental education increase [Adjusted odds: 0.7 (95%CI: 0.6-0.8) for higher income/education compared to low income/no qualifications]. However, if the parent plays with the child in high income families the child is more likely to walk to school [Adjusted odds: 1.67 (95%CI: 1.3-2.1)]. Children taking part in organised activities are from higher income, higher education families, with a car, in a "good" area with non-working mothers. However, in low socio-economic families where the parent plays with the child the child is more likely to take part in organised activities [Adjusted odds: 2.0 (95% CI: 1.5-2.7)].

Conclusions

Income is an important determinant of the type of activity available to children. Families that report good health behaviours (non-smoking, low TV viewing) and play with their children show higher levels of physical activity. Thus, parenting practice appears to have a strong impact on their child's physical activity.