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Table 1 Characteristics of interventions on active transportation to and from school (N = 14)

From: A systematic review of interventions for promoting active transportation to school

Author and country (locality) Sample and age (y) Intervention study design and duration Active transportation outcome measure Other outcome measures Results from transportation outcomes Results from other outcomes
Boarnet et al. [23, 24] USA (cities in California) 862 parents of children age 8-11y: 486 in experimental group and 376 in control group. Quasi-experimental design with posttest assessment at 10 experimental/control schools. Duration: 3 years (Spring 2000-Fall 2003). Parent-reported frequency of child walking and biking to school with the question: "Would you say that your child now walks or bicycles to school: (1) less than before the project described above was built; (2) the same amount as before the project was built; (3) more than before the project was built". Parent-reported whether their children's passed the SRTS project. 72% of parents stated that children walked/biked the same before and after the SRTS construction; 18% stated less and 11% stated more. 56% of parents responded that their child passed the SRTS project along their usual route to school. There was a greater increase in walking among those who passed the SRTS project (P < 0.01) after sidewalk improvements and traffic control projects (primarily traffic signals). Children who passed completed SRTS projects were more likely to show increases in walking or bicycling to school than were children who would not pass by projects (15% vs. 4%; P < 0.01).
  1778 parents of children age 8-11 y. Quasi-experimental with pre-post assessment at 10 experimental schools. Duration: 3 years (Spring 2000-Fall 2003). Parent-reported frequency of child walking and biking to school (reported above) and on-site observations on counts of walking. Parent-reported perceptions on safety. Children walking increased after sidewalk improvement projects in 5 school sites (from 10% to 850%). Children walking increased after traffic signal improvement projects in 2 school sites. Children walking increased after crosswalk and crosswalk signal improvement projects in 1 school site and decreased in another. Successful implementation in 50% of the projects: - 3 sidewalk gap closure projects showed success: observed children walking exclusively on the sidewalk increased 30%, 70% and 28% before and after SR2S construction in 3 school sites. - 2 replacement of four-way stops with traffic signals showed success: more parents after the SRTS project construction reported that it would increase safety (23% increase) and 19% more parents reported that the project was important (19% increase), compared with before SRTS project construction.
Heelan KA et al. [25] USA (Midwestern community in Nebraska) 324 children: 201 age 8.1 (1.7) y in experimental group and 123 age 8.4(1.6) y in control group. Quasi-experimental with pre- 3/5 post (May 2005, September 2005, May 2006/winter 2005, spring 2005, fall 2005, winter 2006, spring 2006) assessments with 1 control and 2 experimental schools. Duration: 2 years (2005-2006) Child-reported frequency of walking to and from school, using large posters placed in each classroom and children simply circled a picture of a person walking, biking or riding in a car or bus each morning and afternoon during all the week (5 post assessments). Objective-measured physical activity (3 post). BMI based on measured height and weight and skinfold thickness (3 post). Children at experimental and control groups used similar modes of transportation in the pretest: 27% actively commuted to school and 34.5% actively commuted home from school, at least once a week. Children at experimental group actively commuted more than children at control group at each posttest assessment (P < 0.05). 70.5% children at experimental group met the Healthy People 2010 recommendations (walking 50% of the time) compared with 24.7% of children at control group (results averaged across the 2 years). Experimental participants obtained significantly more daily physical activity than control participants (P < 0.05). Across all schools, frequent walkers obtained 25% more physical activity (P < 0.05), gained 58% less body fat (P < 0.05), and attenuated BMI by 50% (P < 0.05) compared with passive commuters. There were no statically significant differences in changes in body composition over 2 years intervention.
Jordan et al. [26] USA (Tooele County, Utah) 578 parents and 767 children age 6-11 y. Quasi-experimental pilot study with pre-post assessment at 2 control and 2 experimental schools. Duration: 1 year (June 2005-May 2006) Parent-reported frequency of child walking and biking to school. BMI z-score based on measured height and weight; parent-reported physical activity and sedentary habits of child; and child-report of their own physical activity, dietary and sedentary habits, and exercise self-efficacy. Children at experimental schools walked or biked to school more often than control children (P < 0.001), both at pre and post-test. While children in both conditions increased the days per week they walked or biked to school between pre- and post-test, the change was only significant at control schools (P < 0.001). Children in both the experimental and control cohorts showed an increased in BMI z-score, but only significant in controls. No significant differences between experimental and control children in any of the physical activity behaviors measured. Children in experimental cohort reported drinking significantly fewer soft drinks per day than children in control cohort at posttest.
Kong et al. [27] USA (Alburquerque, New Mexico) 22 children age 5-11 y and 9 parents/relatives age 20-59 y. Quasi-experimental, pilot study with post and while intervention assessment at 2 experimental schools. Duration: 10 weeks (spring 2006) Parent-reported and children-reported frequency of child walking to school (post). Monitoring of students and volunteer's attendance (while intervention). BMI percentile based on measured height and weight (pre-post); children-reported and parent/relatives-reported satisfaction (post : retrospective); parent/relative's perceptions and suggestions in a focus group (post). Lead WSB parent's perceptions in interviews (post assessment). Children walked 3.5 days and adults volunteers walked 4 days during the week intervention. 5 of 9 parents/relatives rated that WSB increased their children's walking "a lot", 4 rated it as increased "somewhat" and none rated it as "not at all". Children reported that they walked more during the intervention. Children and parent/relatives expressed high enthusiasm in the WSB and reported that WSB provided a supportive and safe environment to promote physical activity and social interaction. 18 children reported that during the week intervention they were playing more active games and drinking fewer sodas, 17 reported to be eating more fruits and vegetables, 16 reported to be drinking fewer juices and 15 reported to watch less TV.
McKee R et al. [35] United Kingdom (Scotland, West Dunbartonshire) 60 children age 9 y: 31 in experimental group and 29 in control group. Quasi-experimental with pre-post assessment at 1 control and 1 experimental schools. Duration: 10 weeks (Easter-summer break) Child-reported method of travel, route and distance to school, and distance travelled by mode, using a computerized mapping program. Child-reported stage of behavior change, benefits, motivations and barriers for active commuting to school, using an online computerized questionnaire. Children at experimental school increased the walking distance to school 389% and children at control school increased 17% (post inter-group P < 0.001). Children at experimental school decreased the car distance to school 57.5% and children at control school increased 1.5% (post inter-group P < 0.001). 71% of children in the experimental school progressed to a higher behavior's stage or remained in the "action" and "maintenance" stages compared with 52% of the control school, in relation to active journey to school.
Mendoza JA et al.[28] USA (Seattle, Washington) 820 children age 5-11 y: 347 in experimental group and 293,180 in two control groups. Quasi-experimental with pre-3 post (1-month, 6-month, 12-month) assessment at 2 control and 1 experimental schools. Duration: 1 year (March 2005 - March 2006) Child-reported frequency of walking and being driven to school. Students were asked to raise their hands once to answer: "How did you get to school today? a) walked with an adult, b)walked without an adult, c)biked, d)by school bus, e)by metro bus, f)by carpool and g)by car. Monitoring of children's weekly attendance. Parent leaders and volunteer's opinion in face-to-face interviews. Children who walked to school in both experimental and control schools in pretest were not different (p = 0.39). Children at experimental schools walked to school more than children at control schools at 1-month (p = 0.001), 6-month (p = 0.001) and 12-month post assessment (p = 0.001).  
Merom et al. [32] Australia (New South Wales) 812 parents of children age 5-12 y, 717 schools Observational with pre-3post (every year) assessment at 265 experimental schools. Duration: 4 years (2001-2004) -4days (1st April)-. Parent-reported frequency of child modes of commuting to/from school and participation in WSTSD, using computer-assisted telephone interview system and asking: 1) "did your child participate in the WSTSD on Friday 5 April?" If yes, "What did the child do? walked all the way to school, walked part of the way to school, wore a t-shirt or tattoo and other. And 2) 'In a usual week, how does your child get to and from school every day of the week? walk, cycle, car or bus" (post assessment 1, year 2002). Monitoring of attendance in WSTSD and schools data. School-reported participation, students and parent's involvement in walking, curriculum and activities (post 1, year 2002). Parent-reported attitude towards WSTSD, barriers to walking, awareness of WSTSD media campaign and participation (post 1, year 2002). 31% more children walked to school on WSTSD than a normal Friday. WSTSD increased the prevalence of walking to school by 6.8%, at a population level. The school-reported prevalence estimate of walking to school (19%), was similar to rates reported by parents (21.8%). Over the 4 years, 53% of all primary schools in NSW had participated at least once in WSTSD and 15% had participated for at least 3 years. The overall increase in school participation from 2001 to 2004 is 66%. Significantly more schools from urban than rural regions had participated (P < 0.05). Most schools stated they would participate in next year's event because it raises awareness of road safety (84%) and reinforces students' knowledge of safe pedestrian behavior (79%). Parent's awareness, participation and additional walking on WSTSD decreased. 73% of the parents confirmed they would like their child to participate next year and 20% said 'no' because school was too far away or work commitments.
Rowland et al. [36] United Kingdom (London boroughs of Camden and Islington) 1386 children age 7-11 y: 714 in experimental group and 672 in control group. Experimental (randomized control trial) with pre-post assessment at 11 experimental and 10 control schools. Duration: 1 school year (1997-1998). Parent-reported frequency of child modes of commuting to/from school; survey was offered in English, Bengali, Somali, Greek, Turkish, Chinese and Albanian. Parent-report concerns about safety on the journey to school in relation to traffic, abduction and bullying. School travel plans implementation using interview with school's head teachers (post intervention). Frequencies of modes of transportation to and from school were similar in both experimental and control groups at pre and post-test. In post-test, experimental schools reported 70% of children walking, 24% travelling by car and 6% cycled or used public transport; in control schools 71% walked, 23% travelled by car and 7% cycled or used public transport. 2 of 11 experimental schools and 1 of 10 control schools reported having travel plans prior to the study. One year later, 9 of 11 experimental schools and 0 of 10 control schools had a written travel plan; and all these 9 experimental schools implemented some form of Safe Routes activities, compared to 4 of the 10 control schools.
Sirard et al. [29] USA (Menlo Park, California). 11 children age 8-11 y: 5 in experimental group and 6 in control group. Experimental (randomized controlled trial) with pre-post assessment a 1 experimental and 1 control groups in 1 school. Duration: 2 months (March - April 2005)   Objective-measured physical activity during 14 days. Parent's and children's opinions about WSB, using interview (post). Experimental children increased their moderate to vigorous physical activity during the commute time (45 minutes before school) 14 minutes/day more than control children. No significant differences were detected for other weekday periods and no significant differences were detected between groups (all P ≥ 0.40) for physical activity. Experimental children required 10 to 36 minutes to walk to school, which was proportional to the distance travelled 0.4-1.1 km (mean 0.8 km).
Staunton et al. [30] USA (Marin County, California) 1743 students age 6-15 y Quasi-experimental with pre and 3 post (spring-01, fall-01, spring-02) assessments at 11 experimental schools*. Duration: 2 school years (2000-2002) Child-reported frequency and mode of travelling to school. Students raised their hands to indicate the mode of traveling that morning during 3 consecutive days and results were averaged. None reported. From fall 2000 to spring 2002, walking increased 64%, biking increased 114%, carpooling increased 91%, and private car use carrying one student decreased 39%. Not applicable.
Tenbrink et al. [31] USA (Jackson, Michigan) Students age 6-11 y Quasi-experimental with pre-3 post (every year) assessment at 4 experimental schools*. Duration: 4 years (2004-2007) Frequency of students walking to school; Safe Routes survey data. Participation in WTS Day. Participation in events and programs. Other community's issues. The number of students walking to school increased: 5% of students walked to school in 2004; 7% in 2005, 11% in 2006 and 15% in 2007. Participation in WTS Day increased from 600 in 2003 to more than 1200 in 2008. The WSB did not sustain growth. There was improvement in physical projects, policies, and walking and biking in the community.
Wen LM et al. [33] Australia (Sydney) 1966 students age 10-12 y and their parents (N = 1606). Experimental (randomized controlled trial) with pre-post assessment at 12 experimental and 12 control schools. Duration: 2 years (2005-2006). Child-reported and parent-reported frequency and mode of travel to/from school. Children answered over 5 consecutive school days the questions "how did you get to school yesterday?" and "how did you get home yesterday?". Parents answered the question: "In a usual school week, how many mornings does your child go to school by each of the following ways?", and a similar question on the afternoon journey from school to home. None reported Students walking to/from school increased in both experimental and control schools, but it increased more in the experimental group (29% vs. 19% in control; p = 0.05). Students travelling by car to school decreased more in the experimental group (42%) than in the control group (32%) (p = 0.14). Not applicable.
Zaccari & Dirkis [34] Australia (Sydney) 243 students age 5-12 y. Quasi-experimental (pilot study) with pre-and 4 post assessments (week-1, week-2, week-3, week-4 during the intervention) at 1 experimental school. Duration: 4 weeks (April 2001) Child-reported frequency and mode of travel to/from school by 2 sources: survey (pretest) and monitoring using daily travel diaries of poster size that were pinned to the classroom doors and each day children recorded the mode to/from school (during intervention). Target group's opinion using 5 focus groups, 2 one-to-one interviews and observations. At pretest, 47% were driven to school and 14% travelled by bus. There was a 3.4% reduction in car trips and a 3.4% increase in walking trips by week 4 of the intervention. For travel to school, the number of children being driven decreased while the number walking increased, for all ages. For travel from school, the number being driven decreased for all classes, and the number walking increased only from children from 5 to 9 y. More than 80% of children lived within walking distance (within 1 kilometer of the school). The parents assisted the Council to identify road safety problems as footpath obstructions, speeding traffic, and poor crossing facilities.
  1. Abbreviations: BMI = body mass index; NA = not applicable; SRTS = Safe Routes to School; WSB = Walking School Bus; WSTSD = Walk Safely to School Day
  2. Sample and Age: The sample reported corresponds to people who answered the transportation and other outcomes. So, if parents reported mode of travel of their children, the sample will be parents. The sample size provided correspond to the transportation outcome in the pretest or if it is not applicable in the posttest, and if it is not applicable the sample size correspond to the outcome with a higher sample size in the pretest measure or if it is not applicable in the posttest. When none sample size is mentioned in the study, it has not been reported, Age is reported in range if it is provided; if it is not, the average of years will be indicate. When age is not provide in the study, an estimation regarding the school were done (i.e., elementary school includes children from 6 to 11 years and middle schools from 12 to 15 years in USA and United Kingdom schools; primary schools includes 5 to 12 years in Australia). Intervention study design: The number of measures (pre, post..., while intervention) corresponds to the maximum number of measure times regarding all the outcomes. Outcome measures: Information about assessment/s for each outcome has been indicated between parentheses only when these are different from the expressed in the intervention study design's column.
  3. *Comparisons were done on a different number of schools over time. In Staunton et al. (2001), results included 6 schools for the first school year and 7 for the second school year, but only 2 schools participated in surveys both years; analysis restricted to these 2 schools produced results similar to those shown in the table. In Tenbrink et al., (2009), number of schools increased along the time and results included 1 school the first year, 3 schools (including the previous) the second year and 4 schools (including the previous) the third and fourth year.