Attitudes to walking and cycling among children, young people and parents: a systematic review

Barriers and facilitators of domain-specific physical activity: a systematic review of reviews

Background

Knowing what facilitates and hinders physical activity behaviour across domains (leisure, travel, work or education, and household) is central for the development of actions for more active lifestyles. Thus, the aim of this systematic review of reviews was to summarize the evidence on barriers and facilitators of domain-specific physical activity.

Methods

We included systematic reviews with or without meta-analysis that investigated the association between modifiable barriers and facilitators and levels of domain-specific physical activity. Reviews published until September 2020 were retrieved from PubMed, ISI Web of Science, Scopus, Regional Library of Medicine (BIREME), and PsycNET, and from the reference list of selected articles. Each review was screened by two independent reviewers for eligibility. Data extracted from selected papers included methodological aspects (number of primary studies, study designs, and age groups); physical activity domains and barriers and facilitators investigated; and direction of association. For each pair of barrier/facilitator and domain-specific physical activity, we recorded the number of positive, negative, and null associations reported across reviews. Quality assessment of each systematic review was performed using the AMSTAR-2 tool.

Results

Forty-four systematic reviews were selected. The evidence base was largest for leisure-time followed by travel-related physical activity. A very small number of reviews included physical activity in work, educational and domestic settings. Across all physical activity domains, factors related to the built environment were more abundant in the reviews than intra and interpersonal factors. Very consistent positive associations were observed between a range of intrapersonal factors and leisure-time physical activity, as well as moderately consistent evidence of positive association for general social support and support from family members. Evidence of moderate consistency was found for the positive association between transport-related physical activity and positive beliefs about consequences, walkability, and existence of facilities that support active travel. Evidence on barriers and facilitators for physical activity at work, educational, and domestic settings was limited in volume and consistency.

Conclusions

Efforts and resources are required to diversify and strength the evidence base on barriers and facilitators of domain-specific physical activity, as it is still limited and biased towards the leisure domain and built environment factors.

Trial registration

PROSPERO CRD42020209710.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14385-1.

Children's experiences of the journey between home and school: A qualitative synthesis using meta-ethnography

This paper uses meta-ethnography to synthesise qualitative and ethnographic studies of children's (aged 5-13) experiences of socio-material environments on their school journey. Most of the 21 papers (18 studies) identified from the systematic search were from high-income countries and used self-report qualitative methods. Our synthesis shows children can feel vulnerable, but also negotiate journeys and manage risks, enjoy shared and solitary mobility, and explore their material environments. School journeys offer children a place to learn and develop agency within their socio-material environments. Attending to these wider benefits of school journeys, alongside supporting children to develop active modes attuned to the risks associated with these journeys, could improve the reach and impact of active school travel initiatives.

Protected and unprotected cycle lanes' effects on cyclists' behaviour

Previous research has suggested that in countries with low cycling rates, a barrier to cycling is the perception that cycling is unsafe. Unfortunately, this perception is accurate in many places, and protected cycle lanes have been advocated as a possible solution. Although some research shows that people tend to feel safer in them, there have been conflicting results regarding protected cycle lanes' safety benefits. Understanding the reasons protected cycle lanes may actually reduce safety is key to promoting active transport modes. One possible reason crash rates may increase is that cyclists may cycle faster in them due to either a decreased mental workload or from reduced perceptions of risk. In the present research, two studies were conducted to examine cyclists' speeds and perceptions of difficulty and safety in both protected and unprotected cycle lanes, as well as streets with no cycle lanes. The first study was an online questionnaire using short video clips from a cyclist's perspective, and the second study was an on-road experiment with a post-ride questionnaire. The studies found that cyclists felt safer with protected cycle lanes, were more willing to allow their children to bike on them and showed less concern towards hazards. There was no evidence of decreased attentional demand while using the protected cycle lanes, but there was some evidence of higher maximum cycling speeds.

The socio-ecological determinants of change in school travel mode over the transition from childhood to adolescence and the association with physical activity intensity

School active travel contributes to young people's physical activity levels, yet the prevalence is low, and declines with age. Based on determinants from the social-ecological model we investigated changes in school travel behaviour over the transition from childhood to adolescence in participants from the baseline and four-year follow-up of the SPEEDY cohort. Descriptive analysis examined how travel behaviours changed and were related to physical activity. Multinomial logistic regression investigated determinants. Some 38% of participants changed travel mode; 66% from active to passive. Passively traveling participants at follow-up showed a decrease in physical activity. Several social-ecological domains were associated with change. Findings suggest multicomponent interventions are required to support active travel in youth.

Do neighbourhood characteristics matter in understanding school children’s active lifestyles? A cross-region multi-city comparison of Glasgow, Edinburgh and Hong Kong

Many studies have explored the influence of individual and neighbourhood factors on active school travel (AST), this novel study is the first to examine how AST and formal extracurricular activities are associated with children’s active lifestyles. The aims of this study were to (a) create an active lifestyle variable (ALIFE) measured in terms of total weekly minutes of AST and extracurricular activities, and (b) explore how ALIFE is associated with different attributes at the individual, household and neighbourhood levels, and how these relationships differ for children aged 10 and 11 years old across the three cities: Glasgow, Edinburgh and Hong Kong. We found environmental factors to be important indicators of lower AST, for example greater parking facility density. The most substantial contribution to children’s overall ALIFE was household income, those from the lowest household group having almost 2 h less ALIFE per-week than those from the highest income.

Access to bike lanes and childhood obesity: A systematic review and meta-analysis

The lack of bike lane access has been a proven risk factor for childhood obesity due to its role in discouraging healthy lifestyles. However, there has not been a systematic review of this important association in the existing literature. This study aims to fill this gap. A literature search was conducted in the Cochrane Library, PubMed, Embase, and Web of Science for studies published from 1 January 2019 onwards that examined the association between bike lane access and weight-related behaviours and outcomes among children aged <18 years. A total of 21 studies were included in this systematic review. Among them, most of the studies showed that bike lane access was significantly associated with children and adolescents' physical activity (PA), whereas only two studies showed a negative association. Meta-analysis also supported these findings and showed that bike lane access was significantly associated with children and adolescents' PA (odds ratio [OR] = 1.57, 95% confidence interval [CI]: 1.37-1.81). Additionally, we reviewed how bike lane characteristics and microenvironment variables such as children and adolescents' choice of bicycle travel mode, the degree of separation of cycle path, cycle path unevenness, and street maintenance were associated with adolescents' preferences and intention to cycle. This systematic review and meta-analysis strongly suggests that bike lane access is associated with children and adolescents' PA. Nonetheless, it was difficult to draw a conclusion on the association between bike lane access and weight-related outcomes.

Effect of Major Life Events on Travel Behaviours: A Scoping Review

The transportation sector accounts for about a quarter of global greenhouse gas emissions. Previous research suggests that major life events may be “windows of opportunity” for travel behaviour change. Our scoping review examined the effects of seven events (transitions to secondary school, post-secondary studies, labour market, marriage, parenthood, retirement, and relocation) on travel behaviours. Five databases were searched (MEDLINE, APA PsycINFO, Web of Science, SportDISCUS, and ProQuest Dissertations and Theses) and 80 articles met inclusion criteria. Relocation was the most commonly examined event (with 51 studies). Findings illustrate that moving to compact neighbourhoods (with shorter commute distance/travel time, greater walkability/access to destinations) was associated with shifts towards sustainable travel modes (e.g., walking, cycling, and transit). Relocation might be particularly conducive to implementing scalable sustainable transportation interventions, as all six interventions with appropriate statistical power were effective. Entry into the labour market was generally associated with increased car use and declines in sustainable transportation. Qualitative studies suggested that attitudes towards cycling may become negative during adolescence, while attitudes towards driving improve, highlighting a need for concerted action. Evidence for other events was less consistent. Research in developing countries remain scarce and further intervention research is needed to enhance quality of evidence.

Parental barriers to active transport to school: a systematic review

OBJECTIVES

We aimed to systematically review parental barriers towards children and adolescents' active transport to school (ATS) in the scientific literature and to provide a categorization of the barriers identified in the studies.

METHODS

A search was conducted through seven online databases, from the beginning of the database to March 2018.

RESULTS

A total of 27 of the identified studies met the inclusion criteria. The main parental barriers reported by parents of children (21 studies) were built environment, traffic safety, distance, crime-related safety and social support. The main parental barriers reported by parents of adolescents (6 studies) were built environment (street connectivity), distance, traffic safety and physical and motivation barriers. The parental barriers associated with ATS were mainly related to the built environment and traffic safety.

CONCLUSIONS

It is crucial to involve parents through interventions to reduce the perception of safety and to increase awareness of the importance of ATS. In addition, these strategies should be complemented by environmental changes performed by local governments.

Comparative Associations of Street Network Design, Streetscape Attributes and Land-Use Characteristics on Pedestrian Flows in Peripheral Neighbourhoods

Research has sufficiently documented the built environment correlates of walking. However, evidence is limited in investigating the comparative associations of micro- (streetscape features) and macro-level (street network design and land-use) environmental measures with pedestrian movement. This study explores the relative association of street-level design-local qualities of street environment-, street network configuration -spatial structure of the urban grid- and land-use patterns with the distribution of pedestrian flows in peripheral neighbourhoods. Street design attributes and ground-floor land-uses are obtained through field surveys while street network configuration is evaluated through space syntax measures. The statistical models indicate that the overall spatial configuration of street network proves to be a stronger correlate of walking than local street-level attributes while only average sidewalk width appears to be a significant correlate of walking among the streetscape measures. However, the most significant and consistent correlate of the distribution of flows is the number of recreational uses at the segment-level. This study contributes to the literature by offering insights into the comparative roles of urban design qualities of the street environment and street network layout on pedestrian movement. The findings also offer evidence-based strategies to inform specific urban design and urban master planning decisions (i.e., the provision of more generous sidewalks on streets with relatively higher directional accessibility) in creating lively, walkable environments.

Assessment of direct and indirect associations between children active school travel and environmental, household and child factors using structural equation modelling

BACKGROUND

Active school travel (AST) is influenced by multiple factors including built and social environments, households and individual variables. A holistic theory such as Mitra's Behavioural Model of School Transportation (BMST) is vital to comprehensively understand these complex interrelationships. This study aimed to assess direct and indirect associations between children's AST and environmental, household and child factors based on the BMST using structural equation modelling (SEM).

METHODS

Data were drawn from Neighbourhoods for Active Kids (NfAK), a cross-sectional study of 1102 children aged 8-13 years (school years 5-8) and their parents from nine intermediate and 10 primary schools in Auckland, New Zealand between February 2015 and December 2016. Data were collected using an online participatory mapping survey (softGIS) with children, a computer-assisted telephone interviewing survey (CATI) with parents, and ArcGIS for built environment attributes. Based on the BMST a conceptual model of children's school travel behaviour was specified for SEM analyses ('hypothesised SEM'), and model modification was made to improve the model ('modified SEM'). SEM analyses using Mplus were performed to test the hypothesised/modified SEM and to assess direct and indirect relationships among variables.

RESULTS

The overall fit of the modified SEM was acceptable (N = 542; Root mean square error of approximation = 0.04, Comparative fit index = 0.94, Tucker-Lewis index = 0.92). AST was positively associated with child independent mobility, child-perceived neighbourhood safety, and parent-perceived importance of social interaction and neighbourhood social environment. Distance to school, and parental perceptions of convenience and concerns about traffic safety were negatively associated with AST. Parental fears of stranger danger were indirectly related to AST through those of traffic safety. Distance to school and child independent mobility mediated relationships between AST and child school year and sex.

CONCLUSIONS

Increasing children's AST requires action on multiple fronts including communities that support independent mobility by providing child friendly social and built environments, safety from traffic, and policies that promote local schools and safe vehicle-free zones around school.

"In my day…"- Parents' Views on Children's Physical Activity and Screen Viewing in Relation to Their Own Childhood

Physical activity and screen viewing are associated with cardio-metabolic risk factors, psychological wellbeing, and academic performance among children. Across the last generation, children’s physical activity and screen viewing behaviours have changed, coinciding with changes to the home and neighbourhood environment. This study aimed to qualitatively explore parents’ views on their 8–9-year-old child’s childhood and how this compares to experiences from their own childhood, with a specific focus on physical activity and screen viewing behaviours. Semi-structured telephone interviews were conducted with 51 parents (mean age = 41.2 years, range 31.5 to 51.5 years), between July and October 2016. Inductive and deductive content analyses were used to explore parents’ perceptions of their child’s physical activity and screen viewing behaviours in comparison to their own childhood behaviours. Interview data revealed that compared to the relative freedom they recalled as children, parents restrict their children’s independent mobility and outdoor play due to concerns about safety. Despite their children having greater access to structured activities than they did as children, parents feel their children are “missing out,” and perceived their own childhood as better with regards to maximising independent and outdoor play and limiting screen viewing. Innovative strategies are needed to change the social norms surrounding children’s independent mobility and outdoor play.

Understanding child and parent perceptions of barriers influencing children's active school travel

BACKGROUND

Physical activity plays a fundamental role in the health and well-being of children. Walking is the most common form of physical activity and the journey to and from school provides an opportunity for children to be active every day. This study examines how child and parent perceptions of barriers to active school travel influences children's behaviour.

METHODS

Participants were recruited from 48 elementary schools in Southwestern Ontario, Canada. The study sample includes 1296 children (ages 9-14 years) who live within walking distance of their school, defined as 1.6 km network distance. Chi-square analysis examined differences between child and parent perceptions of barriers to active school travel. Logistic regression models examined how parent and child perceptions of barriers influence active school travel behaviour, while controlling for key intrapersonal, interpersonal, and physical environment factors.

RESULTS

The results indicate that there are significant differences in how parents and children perceive barriers to active school travel. Model results find older children, children without siblings, households with no vehicles, and children who live closer to school are most likely to use active school travel. Parent perceptions of barriers are found to have a greater influence on children's active school travel behaviour than children's perceptions. Different perceptions of barriers influence active school travel to school compared to returning home from school.

CONCLUSIONS

Child and parent perceptions of barriers to active school travel differ and have different impacts on children's travel behaviour. Understanding how child and parent perceptions of barriers differ can help policymakers and practitioners develop specialized interventions aimed at increasing children's use of active school travel and children's overall physical activity. Interventions used to promote active school travel should focus on safety, as well as perceptions of distance to break parental habits of routinely driving their children to school. Overall, this study highlights the importance of considering both child and parent perceptions to create a safe and accessible environment to allow for an increase in active school travel behaviour among elementary school children who live within walking distance of their school.

Knowledge and Beliefs About Pedestrian Safety in an Urban Community: Implications for Promoting Safe Walking

As more people walk for transport and exercise, it is possible to avoid a concomitant increase in the number of pedestrian injuries. Understanding how the public views pedestrian safety can help inform the development of prevention strategies that support national efforts to promote walking and walkable communities. As part of the formative research for a community pedestrian safety health promotion campaign, we administered an online questionnaire to employees and students at a large urban medical campus, along with residents in the neighboring communities, to determine their knowledge, attitudes, and behavior regarding pedestrian safety; awareness of relevant traffic safety laws; and effective strategies that could improve pedestrian safety. Pearson Chi square Test of Independence was used to investigate differences between individuals who mainly traveled as drivers versus those who mainly traveled as pedestrians. Statistical significance was established at p < .05. A total of 3808 adults completed the online survey. More drivers than pedestrians reported that pedestrian safety was an important problem (73 and 64%, respectively; p < .001). A large proportion of respondents incorrectly reported the existing state laws addressing right of way, fines, and enforcement, with significant differences between drivers and pedestrians (p < .001). Significantly more pedestrians than drivers supported changing traffic signals to increase crossing time (p = .001), while more drivers than pedestrians supported creating structures to prevent midblock crossing (p = .003). Effective interventions to improve pedestrian safety need to tailor messages for both drivers and pedestrians, increase awareness of the laws, and implement comprehensive strategies.

Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis: a mixed methods review

BACKGROUND

Chronic peripheral joint pain due to osteoarthritis (OA) is extremely prevalent and a major cause of physical dysfunction and psychosocial distress. Exercise is recommended to reduce joint pain and improve physical function, but the effect of exercise on psychosocial function (health beliefs, depression, anxiety and quality of life) in this population is unknown.

OBJECTIVES

To improve our understanding of the complex inter-relationship between pain, psychosocial effects, physical function and exercise.

SEARCH METHODS

Review authors searched 23 clinical, public health, psychology and social care databases and 25 other relevant resources including trials registers up to March 2016. We checked reference lists of included studies for relevant studies. We contacted key experts about unpublished studies.

SELECTION CRITERIA

To be included in the quantitative synthesis, studies had to be randomised controlled trials of land- or water-based exercise programmes compared with a control group consisting of no treatment or non-exercise intervention (such as medication, patient education) that measured either pain or function and at least one psychosocial outcome (self-efficacy, depression, anxiety, quality of life). Participants had to be aged 45 years or older, with a clinical diagnosis of OA (as defined by the study) or self-reported chronic hip or knee (or both) pain (defined as more than six months' duration).To be included in the qualitative synthesis, studies had to have reported people's opinions and experiences of exercise-based programmes (e.g. their views, understanding, experiences and beliefs about the utility of exercise in the management of chronic pain/OA).

DATA COLLECTION AND ANALYSIS

We used standard methodology recommended by Cochrane for the quantitative analysis. For the qualitative analysis, we extracted verbatim quotes from study participants and synthesised studies of patients' views using framework synthesis. We then conducted an integrative review, synthesising the quantitative and qualitative data together.

MAIN RESULTS

Twenty-one trials (2372 participants) met the inclusion criteria for quantitative synthesis. There were large variations in the exercise programme's content, mode of delivery, frequency and duration, participant's symptoms, duration of symptoms, outcomes measured, methodological quality and reporting. Comparator groups were varied and included normal care; education; and attention controls such as home visits, sham gel and wait list controls. Risk of bias was high in one and unclear risk in five studies regarding the randomisation process, high for 11 studies regarding allocation concealment, high for all 21 studies regarding blinding, and high for three studies and unclear for five studies regarding attrition. Studies did not provide information on adverse effects.There was moderate quality evidence that exercise reduced pain by an absolute percent reduction of 6% (95% confidence interval (CI) -9% to -4%, (9 studies, 1058 participants), equivalent to reducing (improving) pain by 1.25 points from 6.5 to 5.3 on a 0 to 20 scale and moderate quality evidence that exercise improved physical function by an absolute percent of 5.6% (95% CI -7.6% to 2.0%; standardised mean difference (SMD) -0.27, 95% CI -0.37 to -0.17, equivalent to reducing (improving) WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) function on a 0 to 100 scale from 49.9 to 44.3) (13 studies, 1599 participants)). Self-efficacy was increased by an absolute percent of 1.66% (95% CI 1.08% to 2.20%), although evidence was low quality (SMD 0.46, 95% CI 0.34 to 0.58, equivalent to improving the ExBeliefs score on a 17 to 85 scale from 64.3 to 65.4), with small benefits for depression from moderate quality evidence indicating an absolute percent reduction of 2.4% (95% CI -0.47% to 0.5%) (SMD -0.16, 95% CI -0.29 to -0.02, equivalent to improving depression measured using HADS (Hospital Anxiety and Depression Scale) on a 0 to 21 scale from 3.5 to 3.0) but no clinically or statistically significant effect on anxiety (SMD -0.11, 95% CI -0.26 to 0.05, 2% absolute improvement, 95% CI -5% to 1% equivalent to improving HADS anxiety on a 0 to 21 scale from 5.8 to 5.4; moderate quality evidence). Five studies measured the effect of exercise on health-related quality of life using the 36-item Short Form (SF-36) with statistically significant benefits for social function, increasing it by an absolute percent of 7.9% (95% CI 4.1% to 11.6%), equivalent to increasing SF-36 social function on a 0 to 100 scale from 73.6 to 81.5, although the evidence was low quality. Evidence was downgraded due to heterogeneity of measures, limitations with blinding and lack of detail regarding interventions. For 20/21 studies, there was a high risk of bias with blinding as participants self-reported and were not blinded to their participation in an exercise intervention.Twelve studies (with 6 to 29 participants) met inclusion criteria for qualitative synthesis. Their methodological rigour and quality was generally good. From the patients' perspectives, ways to improve the delivery of exercise interventions included: provide better information and advice about the safety and value of exercise; provide exercise tailored to individual's preferences, abilities and needs; challenge inappropriate health beliefs and provide better support.An integrative review, which compared the findings from quantitative trials with low risk of bias and the implications derived from the high-quality studies in the qualitative synthesis, confirmed the importance of these implications.

AUTHORS' CONCLUSIONS

Chronic hip and knee pain affects all domains of people's lives. People's beliefs about chronic pain shape their attitudes and behaviours about how to manage their pain. People are confused about the cause of their pain, and bewildered by its variability and randomness. Without adequate information and advice from healthcare professionals, people do not know what they should and should not do, and, as a consequence, avoid activity for fear of causing harm. Participation in exercise programmes may slightly improve physical function, depression and pain. It may slightly improve self-efficacy and social function, although there is probably little or no difference in anxiety. Providing reassurance and clear advice about the value of exercise in controlling symptoms, and opportunities to participate in exercise programmes that people regard as enjoyable and relevant, may encourage greater exercise participation, which brings a range of health benefits to a large population of people.

Effectiveness of active school transport interventions: a systematic review and update

Background

Active school transport (AST) is a promising strategy to increase children’s physical activity. A systematic review published in 2011 found large heterogeneity in the effectiveness of interventions in increasing AST and highlighted several limitations of previous research. We provide a comprehensive update of that review.

Methods

Replicating the search of the previous review, we screened the PubMed, Web of Science, Cochrane, Sport Discus and National Transportation Library databases for articles published between February 1, 2010 and October 15, 2016. To be eligible, studies had to focus on school-aged children and adolescents, include an intervention related to school travel, and report a measure of travel behaviors. We assessed quality of individual studies with the Effective Public Health Practice Project quality assessment tool, and overall quality of evidence with the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. We calculated Cohen’s d as a measure of effect size.

Results

Out of 6318 potentially relevant articles, 27 articles reporting 30 interventions met our inclusion criteria. Thirteen interventions resulted in an increase in AST, 8 found no changes, 4 reported inconsistent results, and 5 did not report inferential statistics. Cohen’s d ranged from −0.61 to 0.75, with most studies reporting “trivial-to-small” positive effect sizes. Three studies reported greater increases in AST over longer follow-up periods and two Safe Routes to School studies noted that multi-level interventions were more effective. Study quality was rated as weak for 27/30 interventions (due notably to lack of blinding of outcome assessors, unknown psychometric properties of measurement tools, and limited control for confounders), and overall quality of evidence was rated as low. Evaluations of implementation suggested that interventions were limited by insufficient follow-up duration, incomplete implementation of planned interventions, and limited access to resources for low-income communities.

Conclusions

Interventions may increase AST among children; however, there was substantial heterogeneity across studies and quality of evidence remains low. Future studies should include longer follow-ups, use standardized outcome measures (to allow for meta-analyses), and examine potential moderators and mediators of travel behavior change to help refine current interventions.

Trial registration

Registered in PROSPERO: CRD42016033252

Electronic supplementary material

The online version of this article (10.1186/s12889-017-5005-1) contains supplementary material, which is available to authorized users.

Understanding active school travel through the Behavioural Ecological Model

Active school travel (AST) is an important source of physical activity for children and a conceptual understanding of AST is necessary to inform promotion efforts. The aim of this article is to provide a conceptual analysis of AST. All currently identified AST formulations include intra-individual variables which are often recommended as intervention targets. However, existing literature lacks clarity on precisely how these intra-individual variables might shape specific AST interventions. Moreover, evaluative studies of AST interventions typically fail to specify an underpinning theory or model. To address this limitation, the Behavioural Ecological Model (BEM), not previously addressed in AST, is presented to guide this area of research. Based on specific examples, we draw attention to the role of potential antecedents and potential reinforcers of AST, as well as potential reinforcers of motorised travel. Antecedents and reinforcers may help to explain choices of school travel mode, and to inform and increase intervention options to promote AST. Consistent with the BEM, the provision of more immediate consequences, such as fun and material prizes, is an evidence-based strategy for increasing AST which is likely to be low-cost and easier to deliver than alternative interventions. This approach to the study of AST is expected to contribute to similar analyses in this and other areas of behaviour change research, and to a more useful discussion and treatment of theoretical and conceptual behavioural models.

The effect of ambient light condition on road traffic collisions involving pedestrians on pedestrian crossings

Previous research suggests darkness increases the risk of a collision involving a pedestrian and the severity of any injury suffered. Pedestrian crossings are intended to make it safer to cross the road, but it is not clear whether they are effective at doing this after-dark, compared with during daylight. Biannual clock changes resulting from transitions to and from daylight saving time were used to compare RTCs in the UK during daylight and darkness but at the same time of day, thus controlling for potential influences on RTC numbers not related to the ambient light condition. Odds ratios and regression discontinuity analysis suggested there was a significantly greater risk of a pedestrian RTC at a crossing after-dark than during daylight. Results also suggested the risk of an RTC after-dark was greater at a pedestrian crossing than at a location at least 50m away from a crossing. Whilst these results show the increased danger to pedestrians using a designated crossing after-dark, this increased risk is not due to a lack of lighting at these locations as 98% of RTCs at pedestrian crossings after-dark were lit by road lighting. This raises questions about the adequacy and effectiveness of the lighting used at pedestrian crossings.

Impact of offering cycle training in schools upon cycling behaviour: a natural experimental study

BACKGROUND

England's national cycle training scheme, 'Bikeability', aims to give children in England the confidence to cycle more. There is, however, little evidence on the effectiveness of cycle training in achieving this. We therefore examined whether delivering Bikeability was associated with cycling frequency or with independent cycling.

METHODS

We conducted a natural experimental study using information on children aged 10-11 years participating in the nationally-representative Millennium Cohort Study. We identified Cohort participants whose schools had offered Bikeability in 2011-2012 using operational Bikeability delivery data (children in London excluded, as delivery data not available). Our natural experimental design capitalised on the fact that Cohort participants were surveyed at different times during 2012 and were also offered Bikeability at different times during 2012. This allowed us to compare cycling levels between children whose schools delivered Bikeability before their survey interview ('intervention group', N = 2563) and an otherwise comparable group of children whose schools delivered Bikeability later in the year ('control group', N = 773). Parents reported whether their child had completed formal cycle training; their child's cycling frequency; whether their child ever made local cycling trips without an adult; and other child and family factors. We used Poisson regression with robust standard errors to examine whether cycling behaviour differed between the intervention and control groups.

RESULTS

Children whose school had offered Bikeability were much more likely to have completed cycle training than the control group (68% vs. 28%, p < 0.001). There was, however, no evidence that delivering Bikeability in school was associated with cycling more often (49.0% cycling at least once per week in the intervention group vs. 49.6% in the control group; adjusted risk ratio 0.99, 95% CI 0.89, 1.10). There was likewise no evidence of an association with cycling independently (51.5% in the intervention group vs. 50.1% in the control group; adjusted risk ratio 0.97, 95% CI 0.89, 1.06).

CONCLUSIONS

Offering high-quality cycle training free at the point of delivery in English schools encourages children to do cycle training, but we found no evidence of short-term effects on cycling frequency or independent cycling. Future evaluation should investigate longer-term effects on these and other stated Bikeability objectives such as increasing cycling safety.

Cross-sectional associations between high-deprivation home and neighbourhood environments, and health-related variables among Liverpool children

OBJECTIVES

(1) To investigate differences in health-related, home and neighbourhood environmental variables between Liverpool children living in areas of high deprivation (HD) and medium-to-high deprivation (MD) and (2) to assess associations between these perceived home and neighbourhood environments and health-related variables stratified by deprivation group.

DESIGN

Cross-sectional study.

SETTING

10 Liverpool primary schools in 2014.

PARTICIPANTS

194 children aged 9-10 years.

MAIN OUTCOME MEASURES

Health-related variables (self-reported physical activity (PA) (Physical Activity Questionnaire for Older Children, PAQ-C), cardiorespiratory fitness, body mass index (BMI) z-scores, waist circumference), home environment variables: (garden/backyard access, independent mobility, screen-based media restrictions, bedroom media) and neighbourhood walkability (Neighbourhood Environment Walkability Scale for Youth, NEWS-Y).

EXPLANATORY MEASURES

Area deprivation.

RESULTS

There were significant differences between HD and MD children's BMI z-scores (p<0.01), waist circumference (p<0.001) and cardiorespiratory fitness (p<0.01). HD children had significantly higher bedroom media availability (p<0.05) and independent mobility scores than MD children (p<0.05). MD children had significantly higher residential density and neighbourhood aesthetics scores, and lower crime safety, pedestrian and road traffic safety scores than HD children, all of which indicated higher walkability (p<0.01). HD children's BMI z-scores (β=-0.29, p<0.01) and waist circumferences (β=-0.27, p<0.01) were inversely associated with neighbourhood aesthetics. HD children's PA was negatively associated with bedroom media (β=-0.24, p<0.01), and MD children's PA was positively associated with independent mobility (β=0.25, p<0.01). MD children's independent mobility was inversely associated with crime safety (β=-0.28, p<0.01) and neighbourhood aesthetics (β=-0.24, p<0.05).

CONCLUSIONS

Children living in HD areas had the least favourable health-related variables and were exposed to home and neighbourhood environments that are unconducive to health-promoting behaviours. Less access to bedroom media equipment and greater independent mobility were strongly associated with higher PA in HD and MD children, respectively. Facilitating independent mobility and encouraging outdoor play may act as effective strategies to enhance PA levels and reduce sedentary time in primary school-aged children.

Built Environment Features that Promote Cycling in School-Aged Children

Previous research shows that children and youth who cycle to/from school are more active and fitter than those who travel by motorized modes. However, rates of cycling are low in many countries, and a better understanding of the correlates of cycling may inform the development of future interventions. This review summarizes the current literature on the built environment correlates of cycling among school-aged children and youth. While both studies of transportation and recreational cycling were eligible, the majority of the 12 included studies focused on the trip to/from school and consistently indicated that shorter distance between home and school is associated with greater odds of cycling. However, little is known about the correlates of cycling for other purposes. Furthermore, other built environment features have not been studied enough to allow strong conclusions to be drawn. Recommendations for future studies are proposed to address the limitations of current evidence.

Cycle training for children: Which schools offer it and who takes part?

PURPOSE

The 'Bikeability' cycle training scheme, a flagship policy of the government in England, aims to give children the skills and confidence to cycle more safely and more often. Little, however, is known about the scheme׳s reach. This paper examined which schools offer Bikeability, and which children participate in cycle training.

METHODS

We used operational delivery data to examine which primary schools in England offered Bikeability. Predictors included the deprivation level of the student body and the local prevalence of cycling. We then examined cycle training participation using data from 6986 participants (age 10-11) in the nationally-representative Millennium Cohort Study. Parents reported whether their child had completed formal cycle training, along with other child and family factors. We used operational data to identify children whose school had previously delivered Bikeability.

RESULTS

55% of schools offered Bikeability to the cohort of children leaving primary school in 2012; this fell to 48% in schools in the top tenth for student deprivation. Among Millennium Cohort participants, 47% of children had completed cycle training; this proportion rose to 68% among children whose schools had offered Bikeability. In adjusted robust Poisson regression models, participation rates were lower among minority ethnic children, particularly South Asians; among children who played sport less often; and among children whose parents were poorer or less educated. The magnitude of these differences was largest among children whose schools had not offered Bikeability (all p≤0.02 for interaction, except for income where p=0.09), although trends in the same direction were observed in schools that had offered Bikeability.

CONCLUSIONS

Offering high-quality cycle training free of charge in English schools reduced but did not eliminate inequalities in cycle training participation. Further promoting the scheme to parents and schools, particularly in deprived areas, would be expected to increase uptake and help reduce current inequalities in participation.

Educación vial y movilidad en la Infancia

Resumen:La motorización creciente de los desplazamientos ha convertido al ambiente urbano en un lugar cada vez más hostil para los niños y niñas, quienes se encuentran entre los grupos humanos más vulnerables del tránsito. En esta etapa del desarrollo, la educación puede ser una herramienta clave para prevenir comportamientos de riesgo y promocionar hábitos de movilidad más saludables. El presente trabajo discute algunos aspectos relacionados con la educación vial en la infancia. Se destaca la importancia de considerar los patrones de movilidad típicos de cada edad, y de promover el uso de medios de transporte más saludables, equitativos y sustentables. Se señala además la necesidad de complementar las acciones educativas con intervenciones multi-sectoriales a diferente nivel.

Participatory Research as One Piece of the Puzzle: A Systematic Review of Consumer Involvement in Design of Technology-Based Youth Mental Health and Well-Being Interventions

Background

Despite the potential of technology-based mental health interventions for young people, limited uptake and/or adherence is a significant challenge. It is thought that involving young people in the development and delivery of services designed for them leads to better engagement. Further research is required to understand the role of participatory approaches in design of technology-based mental health and well-being interventions for youth.

Objective

To investigate consumer involvement processes and associated outcomes from studies using participatory methods in development of technology-based mental health and well-being interventions for youth.

Methods

Fifteen electronic databases, using both resource-specific subject headings and text words, were searched describing 2 broad concepts-participatory research and mental health/illness. Grey literature was accessed via Google Advanced search, and relevant conference Web sites and reference lists were also searched. A first screening of titles/abstracts eliminated irrelevant citations and documents. The remaining citations were screened by a second reviewer. Full text articles were double screened. All projects employing participatory research processes in development and/or design of (ICT/digital) technology-based youth mental health and well-being interventions were included. No date restrictions were applied; English language only. Data on consumer involvement, research and design process, and outcomes were extracted via framework analysis.

Results

A total of 6210 studies were reviewed, 38 full articles retrieved, and 17 included in this study. It was found that consumer participation was predominantly consultative and consumerist in nature and involved design specification and intervention development, and usability/pilot testing. Sustainable participation was difficult to achieve. Projects reported clear dichotomies around designer/researcher and consumer assumptions of effective and acceptable interventions. It was not possible to determine the impact of participatory research on intervention effectiveness due to lack of outcome data. Planning for or having pre-existing implementation sites assisted implementation. The review also revealed a lack of theory-based design and process evaluation.

Conclusions

Consumer consultations helped shape intervention design. However, with little evidence of outcomes and a lack of implementation following piloting, the value of participatory research remains unclear.

Pediatric bicycle-related head injuries: a population-based study in a county without a helmet law

BACKGROUND

Head injuries are the leading cause of death among cyclists, 85 % of which can be prevented by wearing a bicycle helmet. This study aims to estimate the incidence of pediatric bicycle-related injuries in Olmsted County and assess differences in injuries between those wearing helmets vs. not.

METHODS

Olmsted County, Minnesota residents 5 to 18 years of age with a diagnostic code consistent with an injury associated with the use of a bicycle between January 1, 2002, and December 31, 2011, were identified. Incidence rates were calculated and standardized to the age and sex distribution of the 2000 US white population. Type of injuries, the percentage requiring head CT or X-ray, and hospitalization were compared using a chi-square test. Pediatric intensive care unit (PICU) admission, permanent neurologic injury, seizure, need for mechanical ventilation, and mortality were compared using Fisher's exact test.

RESULTS

A total of 1189 bicycle injuries were identified. The overall age-adjusted incidence rate of all injuries was 278 (95 % CI, 249 to 306) per 100,000 person-years for females and 589 (95 % CI, 549 to 629) for males. The corresponding rates for head injuries were 104 (95 % CI, 87 to 121) for females and 255 (95 % CI, 229 to 281) for males. Of patients with head injuries, 17.4 % were documented to have been wearing a helmet, 44.8 % were documented as not wearing a helmet, and 37.8 % had no helmet use documentation. Patients with a head injury who were documented as not wearing a helmet were significantly more likely to undergo imaging of the head (32.1 percent vs. 11.5 %; p < 0.001) and to experience a brain injury (28.1 vs. 13.8 %; p = 0.008).

CONCLUSIONS

Children and adolescents continue to ride bicycles without wearing helmets, resulting in severe head and facial injuries and mortality.

A cross-sectional study of demographic, environmental and parental barriers to active school travel among children in the United States

Background

Promoting daily routine physical activities, such as active travel to school, may have important health implications. Practitioners and policy makers must understand the variety of factors that influence whether or not a child uses active school travel. Several reviews have identified both inhibitors and promoters of active school travel, but few studies have combined these putative characteristics in one analysis. The purpose of this study is to examine associations between elementary school children’s active school travel and variables hypothesized as correlates (demographics, physical environment, perceived barriers and norms).

Methods

The current project uses the dataset from the National Evaluation of Walk to School (WTS) Project, which includes data from 4^th and 5^th grade children and their parents from 18 schools across the US. Measures included monthly child report of mode of school travel during the previous week (n = 10,809) and perceived barriers and social norms around active school travel by parents (n = 1,007) and children (n = 1,219). Generalized linear mixed models (GLMM) with log-link functions were used to assess bivariate and multivariate associations between hypothesized correlates and frequency of active school travel, assuming random school effect and controlling for the distance to school.

Results

The final model showed that the most relevant significant predictors of active school travel were parent’s perceived barriers, specifically child resistance (Estimate = −0.438, p < 0.0001) and safety and weather (Estimate = −0.0245, p < 0.001), as well as the school’s percentage of Hispanic students (Estimate = 0.0059, p < 0.001), after adjusting for distance and including time within school cluster as a random effect.

Conclusions

Parental concerns may be impacting children’s use of active school travel, and therefore, future interventions to promote active school travel should more actively engage parents and address these concerns. Programs like the Walk to School program, which are organized by the schools and can engage community resources such as public safety officials, could help overcome many of these perceived barriers to active transport.

Young adult perceptions of Australia's physical activity recommendations for adults

ISSUES ADDRESSED

Physical activity recommendations for adults worldwide advise participation in moderate-intensity physical activity, such as walking, on most days of the week. Younger adults report the lowest prevalence of walking. This mixed-methods study explores the salience of Australia's activity recommendations around moderate-intensity physical activity, particularly walking, for young Australian adults.

METHODS

Semistructured interviews were conducted with 24 young Australians aged 17-25 years. During interviews, Australia's physical activity recommendations for adults were explained to participants, highlighting the inclusion of moderate-intensity physical activity such as walking. Participants were asked to comment on the recommendations and walking for physical activity and exercise. Data from interviews underwent an iterative thematic form of analysis. Participants also completed the International Physical Activity Questionnaire (IPAQ) and were asked to complete a pedometer diary.

RESULTS

No participant was classified as sedentary; twenty three participants reported walking for transport and nine for leisure (IPAQ). During interviews, the majority of participants (n=20) did not identify walking as physical activity or exercise. Participants focussed on the cardiorespiratory (fitness) benefits associated with physical activity and believed walking was of insufficient intensity to achieve these benefits at their age.

CONCLUSIONS

Walking was considered an everyday activity and of insufficient intensity to achieve any health or fitness benefits. SO WHAT?: The belief that only vigorous physical activity conveys any fitness benefits may act as a barrier to participation in moderate-intensity physical activity such as walking, particularly among sedentary young people.

The physical activity profile of active children in England

BACKGROUND

In line with WHO guidelines, the UK government currently recommends that school-aged children participate in at least 60 minutes, and up to several hours, of at least moderate physical activity on a daily basis. A recent health survey indicates that the amount of reported physical activity varies by age, gender and socioeconomic status. The objective of this study is to identify what types of activity contribute most towards overall physical activity in children who achieve the UK physical activity recommendations; and how this varies according to age, gender and socioeconomic status.

METHODS

Self-reported physical activity was captured through the Health Survey for England 2008, a nationally representative, cross-sectional survey. We analysed data from 1,110 children aged 5-15 years who reported meeting the UK physical activity recommendations. The proportions of total physical activity achieved in various domains of activity were calculated and associations with age, gender and socioeconomic status were examined.

RESULTS

Active play was the largest contributor to overall physical activity (boys = 48%, girls = 53%), followed by walking (boys = 17%, girls = 23%). Active school travel contributed only a small proportion (6% for boys and girls). With increasing age, the contribution from active play decreased (rho = -0.417; p < 0.001) and the contribution of walking (rho = 0.257; p < 0.001) and formal sport (rho = 0.219; p < 0.001) increased. At all ages, sport contributed more among boys than girls. Sport contributed proportionately less with increasing deprivation (rho = -0.191; p < 0.001).

CONCLUSIONS

The contributors to overall physical activity among active children varies with age, socioeconomic status and gender. This knowledge can be used to target interventions appropriately to increase physical activity in children at a population level.

Individual, socio-cultural and environmental predictors of uptake and maintenance of active commuting in children: longitudinal results from the SPEEDY study

Background

Active commuting is prospectively associated with physical activity in children. Few longitudinal studies have assessed predictors of change in commuting mode.

Purpose

To investigate the individual, socio-cultural and environmental predictors of uptake and maintenance of active commuting in 10 year-old children.

Methods

Children were recruited in 2007 and followed-up 12 months later. Children self-reported usual travel mode to school. 31 child, parent, socio-cultural and physical environment characteristics were assessed via self-reported and objective methods. Associations with uptake and maintenance of active travel were studied using multi-level multiple logistic regression models in 2012.

Results

Of the 912 children (59.1% girls, mean ± SD baseline age 10.2 ± 0.3 yrs) with complete data, 15% changed their travel mode. Those children who lived less than 1 km from school were more likely to take up (OR: 4.73, 95% CI: 1.97, 11.32, p = 0.001) and maintain active commuting (OR: 2.80 95% CI: 0.98, 7.96, p = 0.02). Children whose parents reported it was inconvenient to use the car for school travel were also more likely to take up (OR: 2.04, 95% CI: 1.08, 3.85, p = 0.027) and maintain their active commuting (OR: 5.43 95% CI: 1.95, 15.13, p = 0.001). Lower socio-economic status and higher road safety were also associated with uptake.

Conclusions

Findings from this longitudinal study suggest that reducing the convenience of the car and improving the convenience of active modes as well as improving the safety of routes to school may promote uptake and maintenance of active commuting and the effectiveness of these interventions should be evaluated

Bicycle guidelines and crash rates on cycle tracks in the United States

OBJECTIVES

We studied state-adopted bicycle guidelines to determine whether cycle tracks (physically separated, bicycle-exclusive paths adjacent to sidewalks) were recommended, whether they were built, and their crash rate.

METHODS

We analyzed and compared US bicycle facility guidelines published between 1972 and 1999. We identified 19 cycle tracks in the United States and collected extensive data on cycle track design, usage, and crash history from local communities. We used bicycle counts and crash data to estimate crash rates.

RESULTS

A bicycle facility guideline written in 1972 endorsed cycle tracks but American Association of State Highway and Transportation Officials (AASHTO) guidelines (1974-1999) discouraged or did not include cycle tracks and did not cite research about crash rates on cycle tracks. For the 19 US cycle tracks we examined, the overall crash rate was 2.3 (95% confidence interval = 1.7, 3.0) per 1 million bicycle kilometers.

CONCLUSIONS

AASHTO bicycle guidelines are not explicitly based on rigorous or up-to-date research. Our results show that the risk of bicycle-vehicle crashes is lower on US cycle tracks than published crashes rates on roadways. This study and previous investigations support building cycle tracks.

Factors influencing mode of transport in older adolescents: a qualitative study

Background

Since a decline in activity levels occurs in adolescence, active transport could be important to increase daily physical activity in older adolescents (17–18 years). To promote active transport, it is necessary to be aware of the barriers and facilitators of this type of transport, but also of other transport modes. This study sought to uncover the factors influencing the choice of transport mode for short distance travel to various destinations in older adolescents using focus groups.

Methods

Thirty-two focus group volunteers (mean age of 17 ± 1.2 years) were recruited from the two final years of the secondary school in Antwerp (Belgium). Five focus groups were conducted (five to eight participants/group). Content analysis was performed using NVivo 9 software (QSR International). Grounded theory was used to derive categories and subcategories.

Results

Data were categorized in three main themes with several subcategories: personal factors (high autonomy, low costs and health), social factors (good social support) and physical environmental factors (short travel time, good access to transport modes and to facilities, good weather, an adapted built environment, perceived safety and ecology).

Conclusions

For older adolescents, the interplay between short travel time, high autonomy, good social support, low costs, good access to transport modes and facilities, and good weather was important for choosing active transport over other transport forms for travelling short distances to various destinations. Other well-known factors such as safety, ecology and health seemed not to have a big influence on their transport mode choice.

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.

The role of systematic reviews of qualitative evidence in evaluating interventions: a case study

Systematic reviews of qualitative evidence have been widely used to provide information on the context and implementation of interventions, and their potential barriers and facilitators. However, such reviews face a number of methodological challenges, and there are ongoing debates as to how qualitative evidence can best be used to inform our understanding of interventions. In this paper, we use a case study of two systematic reviews of qualitative evidence on the prevention of skin cancer to explore these issues. We find that qualitative evidence not directly related to interventions is likely to be of value for such reviews, that it is often not possible to construct fully comprehensive search strategies, and that there are diminishing returns to the synthesis, in terms of added value or insight, from the inclusion of large numbers of primary studies. We conclude that there are a number of ways in which systematic reviews of qualitative evidence can be utilised in conjunction with evidence on intervention effectiveness, without compromising the rigour of the review process. In particular, the use of theory to inform frameworks for synthesis is a promising way to integrate a broader range of qualitative evidence. Copyright © 2012 John Wiley & Sons, Ltd.

Do the health benefits of cycling outweigh the risks?

Although from a societal point of view a modal shift from car to bicycle may have beneficial health effects due to decreased air pollution emissions and increased levels of physical activity, shifts in individual adverse health effects such as higher exposure to air pollution and risk of a traffic accident may prevail. We have summarized the literature for air pollution, traffic accidents, and physical activity using systematic reviews supplemented with recent key studies. We quantified the impact on all-cause mortality when 500,000 people would make a transition from car to bicycle for short trips on a daily basis in the Netherlands. We estimate that beneficial effects of increased physical activity are substantially larger (3-14 months gained) than the potential mortality effect of increased inhaled air pollution doses (0.8-40 days lost) and the increase in traffic accidents (5-9 days lost). Societal benefits are even larger because of a modest reduction in air pollution and traffic accidents. On average, the estimated health benefits of cycling were substantially larger than the risks relative to car driving for individuals shifting their mode of transport.

Guidance for evidence-informed policies about health systems: rationale for and challenges of guidance development

In the first paper in a three-part series on health systems guidance, Xavier Bosch-Capblanch and colleagues examine how guidance is currently formulated in low- and middle-income countries, and the challenges to developing such guidance.

Importance of characteristics and modalities of physical activity and exercise in defining the benefits to cardiovascular health within the general population: recommendations from the EACPR (Part I)

Over the last decades, more and more evidence is accumulated that physical activity (PA) and exercise interventions are essential components in primary and secondary prevention for cardiovascular disease. However, it is less clear whether and which type of PA and exercise intervention (aerobic exercise, dynamic resistive exercise, or both) or characteristic of exercise (frequency, intensity, time or duration, and volume) would yield more benefit in achieving cardiovascular health. The present paper, as the first of a series of three, will make specific recommendations on the importance of these characteristics for cardiovascular health in the population at large. The guidance offered in this series of papers is aimed at medical doctors, health practitioners, kinesiologists, physiotherapists and exercise physiologists, politicians, public health policy makers, and the individual member of the public. Based on previous and the current literature, recommendations from the European Association on Cardiovascular Prevention and Rehabilitation are formulated regarding type, volume, and intensity of PA and exercise.

On your bike! a cross-sectional study of the individual, social and environmental correlates of cycling to school

Background

Active school transport (AST) has declined rapidly in recent decades. While many studies have examined walking, cycling to school has received very little attention. Correlates of cycling are likely to differ to those from walking and cycling enables AST from further distances. This study examined individual, social and environmental factors associated with cycling to school among elementary school-aged children, stratified by gender.

Methods

Children (n = 1197) attending 25 Australian primary schools located in high or low walkable neighborhoods, completed a one-week travel diary and a parent/child questionnaire on travel habits and attitudes.

Results

Overall, 31.2% of boys and 14.6% of girls cycled ≥ 1 trip/week, however 59.4% of boys and 36.7% of girls reported cycling as their preferred school transport mode. In boys (but not girls), school neighborhood design was significantly associated with cycling: i.e., boys attending schools in neighborhoods with high connectivity and low traffic were 5.58 times more likely to cycle (95% CI 1.11-27.96) and for each kilometer boys lived from school the odds of cycling reduced by 0.70 (95% CI 0.63-0.99). Irrespective of gender, cycling to school was associated with parental confidence in their child's cycling ability (boys: OR 10.39; 95% CI 3.79-28.48; girls: OR 4.03; 95% CI 2.02-8.05), parental perceived convenience of driving (boys: OR 0.42; 95% CI 0.23-0.74; girls: OR 0.40; 95% CI 0.20-0.82); and child's preference to cycle (boys: OR 5.68; 95% CI 3.23-9.98; girls: OR 3.73; 95% CI 2.26-6.17).

Conclusion

School proximity, street network connectivity and traffic exposure in school neighborhoods was associated with boys (but not girls) cycling to school. Irrespective of gender, parents need to be confident in their child's cycling ability and must prioritize cycling over driving.

Increasing Children’s Physical Activity

Background. Efforts to increase the prevalence of children’s active school transport require evidence to inform the development of comprehensive interventions. This study used a multilevel ecological framework to investigate individual, social, and environmental factors associated with walking to and from school among elementary school-aged children, stratified by gender. Method. Boys aged 10 to 13 years ( n = 617) and girls aged 9 to 13 years ( n = 681) attending 25 Australian primary schools located in high or low walkable neighborhoods completed a 1-week travel diary and a parent/child questionnaire on travel habits and attitudes. Results. Boys were more likely (odds ratio [OR] = 3.37; p < .05) to walk if their school neighborhood had high connectivity and low traffic and less likely to walk if they had to cross a busy road (OR = 0.49; p < .05). For girls, confidence in their ability to walk to or from school without an adult (OR = 2.03), school encouragement (OR = 2.43), scheduling commitments (OR = 0.41), and parent-perceived convenience of driving (OR = 0.24) were significantly associated ( p < .05) with walking. Irrespective of gender and proximity to school, child-perceived convenience of walking (boys OR = 2.17 and girls OR = 1.84) and preference to walk to school (child perceived, boys OR = 5.57, girls OR = 1.84 and parent perceived, boys OR = 2.82, girls OR = 1.90) were consistently associated ( p < .05) with walking to and from school. Conclusion. Although there are gender differences in factors influencing children walking to and from school, proximity to school, the safety of the route, and family time constraints are consistent correlates. These need to be addressed if more children are to be encouraged to walk to and from school.

Assessing the evaluability of complex public health interventions: five questions for researchers, funders, and policymakers

CONTEXT

Evidence to support government programs to improve public health often is weak. Recognition of this "knowledge gap" has led to calls for more and better evaluation, but decisions about priorities for evaluation also need to be addressed in regard to financial restraint.

METHODS

Using England's Healthy Community Challenge Fund as a case study, this article presents a set of questions to stimulate and structure debate among researchers, funders, and policymakers and help make decisions about evaluation within and between complex public health interventions as they evolve from initial concept to dissemination of full-scale intervention packages.

FINDINGS

This approach can be used to identify the types of knowledge that might be generated from any evaluation, given the strength of evidence available in response to each of five questions, and to support a more systematic consideration of resource allocation decisions, depending on the types of knowledge required.

CONCLUSIONS

The principles of this approach may be generalizable, and should be tested and refined for other complex public health and wider social interventions.

Searching for systematic reviews of the effects of social and environmental interventions: a case study of children and obesity

SETTING

Although an important part of the evidence base in health, systematic reviews are not always easy to find. Difficulties are compounded when interventions under review are "social and environmental" (that is, targeting wider determinants of health). The authors explored searches from a descriptive map containing thirty-two systematic reviews evaluating the effectiveness of social and environmental interventions for childhood obesity.

QUESTIONS

Which sources give the highest yield of relevant reviews per 100 records? What is the value of searching databases that index literature beyond the "health" arena when looking for data on the effectiveness of social and environmental interventions?

METHODS

The authors analyzed search results from nineteen databases and calculated the precision and the relative and unique contribution of each source.

RESULTS

Searches of specialist systematic review databases-Database of Abstracts of Reviews of Effects (DARE), Database of Promoting Health Effectiveness Reviews (DoPHER), and Health Technology Assessment (HTA)-had the highest precision, although MEDLINE, CINAHL, and PsycINFO located many additional reviews. The Cochrane Database of Systematic Reviews should be searched for health-related reviews. Searches of education, transportation, social policy, and social sciences databases did not identify additional reviews. Searching websites and bibliographies was important.

CONCLUSIONS

Searches for review-level evidence could profitably start with the specialist review databases. Searches of the major health-related databases are essential, but database searching beyond them may not identify much additional evidence. Internet and hand-search remain important sources of reviews not found elsewhere. Comparison of the results with previous research suggests that appropriate sources for locating primary and secondary evidence may be different.

Do the health benefits of cycling outweigh the risks?

BACKGROUND

Although from a societal point of view a modal shift from car to bicycle may have beneficial health effects due to decreased air pollution emissions, decreased greenhouse gas emissions, and increased levels of physical activity, shifts in individual adverse health effects such as higher exposure to air pollution and risk of a traffic accident may prevail.

OBJECTIVE

We describe whether the health benefits from the increased physical activity of a modal shift for urban commutes outweigh the health risks.

DATA SOURCES AND EXTRACTION

We have summarized the literature for air pollution, traffic accidents, and physical activity using systematic reviews supplemented with recent key studies.

DATA SYNTHESIS

We quantified the impact on all-cause mortality when 500,000 people would make a transition from car to bicycle for short trips on a daily basis in the Netherlands. We have expressed mortality impacts in life-years gained or lost, using life table calculations. For individuals who shift from car to bicycle, we estimated that beneficial effects of increased physical activity are substantially larger (3-14 months gained) than the potential mortality effect of increased inhaled air pollution doses (0.8-40 days lost) and the increase in traffic accidents (5-9 days lost). Societal benefits are even larger because of a modest reduction in air pollution and greenhouse gas emissions and traffic accidents.

CONCLUSIONS

On average, the estimated health benefits of cycling were substantially larger than the risks relative to car driving for individuals shifting their mode of transport.

Factors related to accelerometer-derived physical activity in Pacific children aged 6 years

The objective of this study was to investigate potential factors related to Pacific children's moderate-to-vigorous physical activity (MVPA). A total of 393 Pacific children aged 6 years and their mothers were invited to participate. Participants wore accelerometers over 8 days; height, weight, and waist circumference were measured, and mothers reported on individual, social, and perceived environmental factors. Generalized estimation equation models were used to identify associates of children's daily MVPA. In all, 135 children and 91 mothers were included in analyses. Children spent 24% of time in MVPA; 99% of days had ≥60 minutes of MVPA. Higher maternal MVPA, male sex, longer sunlight hours, and rain-free days were associated with children's MVPA. Approaches for improving activity in Pacific children may be most efficacious if strategies for inclement weather and the encouragement of activity in mothers and, in particular, their daughters are included. Also, 60 minutes of daily MVPA may be insufficient to protect Pacific children from increased body size.

The Model of Children's Active Travel (M-CAT): a conceptual framework for examining factors influencing children's active travel

BACKGROUND

The current decline in children's participation in physical activity has attracted the attention of those concerned with children's health and wellbeing. A sustainable approach to ensuring children engage in adequate amounts of physical activity is to support their involvement in incidental activity such as active travel (AT), which includes walking or riding a bicycle to or from local destinations, such as school or a park. Understanding how we can embed physical activity into children's everyday occupational roles is a way in which occupational therapists can contribute to this important health promotion agenda.

AIMS

To present a simple, coherent and comprehensive framework as a means of examining factors influencing children's AT.

METHODS

Based on current literature, this conceptual framework incorporates the observable environment, parents' perceptions and decisions regarding their children's AT, as well as children's own perceptions and decisions regarding AT within their family contexts across time.

CONCLUSION

The Model of Children's Active Travel (M-CAT) highlights the complex and dynamic nature of factors impacting the decision-making process of parents and children in relation to children's AT. The M-CAT offers a way forward for researchers to examine variables influencing active travel in a systematic manner. Future testing of the M-CAT will consolidate understanding of the factors underlying the decision-making process which occurs within families in the context of their communities.