Table 2

Description, strategies and quality assessment of interventions on active transportation to and from school.

Author and country

Intervention details

Effective-ness

Quality assessment c


Description of Intervention

Intervention strategies a

Cohen's d b

Selection bias

Study design

Control for confounders

Blinding

Data collection

Withdrawals and dropouts

Global rating


Boarnet et al. [23 ,24]. USA

California's SRTS program funds traffic improvement projects. The program focused on construction projects (environmental changes aimed at increasing traffic safety) as opposed to education or traffic law enforcement.10 SRTS projects were constructed and assessed at 10 schools: 5 sidewalk improvements (construction of new sidewalks, filling gaps in the sidewalk network, construction of a walking path and the installation of curbs and curb cuts), 3 crossing improvements (adding crosswalks, installing in-pavement crosswalk lighting and installing a pedestrian activated, "count-down" street-crossing signal that warns pedestrians of the amount of time remaining to cross) and 2 traffic control improvements (installation of a traffic signal).

Projects

a) 0.221** b) -0.087*

*

a) * b) **

a) * b) NA

**

*

a) NA b) *

*


Heelan KA et al. [25]. USA.

WSB is a walk-to-school program where children walk to school in groups along a set route (and with set stops along with way), with adults essentially serving as the bus driver for supervision. An adult leader met the neighborhood children at designated walk-stops at specified times each morning and walked the group to and back school. Eight routes were created for the 2 WSB schools. The WSB was conducted during the entire academic years and was only cancelled when temperatures were below 25 or if it was raining or snowing at the scheduled walk time.

Preparation Programs

0.216**

**

**

*

**

***

*

*


Jordan et al. [26]. USA.

The Gold Medal Schools program is a school-based program that incorporates the state core curriculum for the Centers for Disease Control and Prevention school health indicators, the Healthy People 2010 Objectives, and the Division of Adolescent and School Health's school health index. The goal of the program was to establish policy and environmental supports that give students and staff more opportunities for nutritious food choices, regular physical activity, and tobacco prevention. Schools were encouraged to promote fruits and vegetables at breakfast and lunch and to participate in physical activity programs (e.g., Walk Your Child to School Day, and the President's Challenge for physical fitness). More information available at http://health.utah.gov/hearthighway/gms/ webcite.

Preparation Promotion Programs Policy Projects

NA (low effect)

*

**

*

**

**

*

*


Kong et al. [27]. USA.

A WSB was implemented in the City of Albuquerque. The Police Department was involved and ensured the safety of the route and provided parents with more confidence. The recruitment started 3 months before the intervention with dissemination of flyers, posters, articles, classroom presentations and morning announcements; a part-time WSB coordinator was hired and a lead parent volunteer - who played a pivotal role between the research team and the local community and other parent volunteers who were enrolled - was recruited. All participants and their parents met with health care providers for a physical examination and a discussion about obesity prevention at the beginning of the WSB trial. Two training for WSB parent volunteers were held and during the second training, a local police officer approved designated routes for the WSB. During the walks, 4 health themes were emphasized: get up and play hard for at least 1 hour per day, turn off your television and watch no more than 2 hours per day, eat 5 servings of fruit or vegetable per day, and reduce soda and juice intake to no more than 4 ounces per day. Participants were encouraged to talk about personal strategies for making the health behavior changes on their walks to and from school. One health theme was introduced every 2 weeks and motivational incentives were distributed the week after the message delivery.

Preparation Promotion Programs

NA

*

*

NA

*

*

**

*


McKee R et al [35]. Scotland.

Travelling Green is a school-based active travel project. The teacher, children and their families used a set of written interactive resources of 2 types: curriculum materials (a guide for teachers to support school active travel projects within the curriculum. and across a variety of topic areas in a informative and interactive way appropriate for school children) and children and family resources (set of active travel resources designed to be used by children and families at home to engage them in the project outside the formal curriculum and the primary aim of the pack was to provide practical guidance about how to plan an active journey to school. The pack contained: a customized map of the school community with path networks linking the school, main pedestrian crossing points and familiar landmarks within the community and a distance and time chart provided information about journey times on foot; weekly goal-setting activities to help children and families get ready to walk and improve active travel behaviors and generic information about walking to school).

Preparation Promotion Programs

1.214 ****(outcome: distance)

*

**

*

*

*

***

*


Mendoza JA et al. [28]. USA.

The intervention school assigned a WSB coordinator (responsible for the program) and parent volunteers. The coordinator was hired and trained and was responsible for: establish WSB routes and recruit adult volunteers and students, implement school-wide activities, distribute materials on walking to school and pedestrian safety materials, provide walk to school materials and WSB information in the school newsletter, arrange for classroom presentations on pedestrian safety, organize "Two-Feet Tuesdays'" (a weekly walk to school day), organize walking workshops and the annual walk to school community celebration and conduct and informal evaluation. The WSB routes were chosen by Feet First, school personnel and parents. Both experimental and control schools received standard information on preferred walking routes from the Seattle Public Schools, access to a district-wide school traffic and safety committee, and assistance with school safety patrols.

Preparation Promotion Programs

0.256**

**

**

**

**

*

*

*


Merom et al. [32]. Australia.

New South Wales (NSW) WSTSD is an event repeated annually 1 day in April from 2001 to 2004, managed and coordinate with educational sectors and government agencies with direct interest in children's safety, environment and health and representatives from community. The main objectives of WSTSD were to reinforce safe pedestrian behavior, to promote the health benefits of walking, and create the habit at a very young age, to reduce car dependency and to promote the use of public transport. Paid media advertising before the event promoted WSTSD three weeks before to increase parents' awareness of the campaign messages. All primary schools in NSW were invited to participate and an invitation letter was sent to all principals. Registration was voluntary. Schools that registered were sent a school kit with suggestions for promoting involvement in WSTSD, including a sample letter to parents, suggestions for the school newsletter, a list of road safety activities the school could implement and promotional material (for example, stickers, posters and some t-shirts).

Preparation Promotion Programs

0.190*

*

*

NA

**

*

NA

*


Rowland et al. [36]. United Kingdom.

Assistance and advice from a travel coordinator who had formal teaching qualifications and road safety experience, for 16 hours. Road safety problems and their solutions were identified by meeting with teachers and governors, organizing focus groups of parents and pupils and encouraging the establishment of a school travel working group. Within the working group, specific safety concerns were discussed and advice was given on the development and implementation of a travel plan. The coordinator reviewed draft travel plans and provided advice about how to obtain necessary funding. The coordinator encouraged implementation of the plans by liaison with relevant parties within the local and health authorities.

Preparation Promotion Programs

0.209**

*

***

**

**

*

***

*


Sirard et al. [29]. USA.

A WSB, followed the safest route to school based on the location of the students' homes relative to each other and the school. Students walked at their normal pace but were encouraged to stay together as a group A wagon, pulled by the study team member, was used to transport backpacks and instruments. If a student lived more than 1.6 km from the school, the parent/guardian dropped the student off at one of the other student's homes (1.1 km from school), and he or she walked the remainder of the trip.

Preparation Promotion Programs

2.9 ***** (outcome: PA)

*

***

*

**

***

***

*


Staunton et al. [30]. USA.

The SRTS in Marin County promoted walking and biking to school. Using a multipronged approach, the program identified and created safe routes to schools and invited communitywide involvement. The program had 4 paid staff: program director, educator, traffic engineer and a private consulting firm. The program relied on parent, teacher, and community volunteers to carry out the activities. The activities were: mapping SRTS, Walk and Bike to school days, frequent rider miles contest, classroom education, WSB and bike trains, Newsletter and promotions, networking and presentations on the state and national level.

Preparation Promotion Programs Projects

0.259**

*

**

*

**

*

*

*


Tenbrink et al. [31]. USA.

Project U-Turn focused on active transportation in Jackson (Michigan). The project was an integrated approach with the Active Living by Design Community Action Model and the Michigan safe Routes to School model. Preparation regular meetings, guest speakers and events took place involving youth both as audience and as components of the leadership team. Implementation: the project began with a Safe Routes initiative in local schools and then it was expanded from the schools to other destinations as worksites, churches, parks. Promotion: schools held Walk to School Day events in conjunction with Safe Routes programs; volunteers and media attention raised community awareness of active commuting in the kids and the annual Smart Commute Day was organized. Jackson's Safe route to School initiative was presented at national conferences. Programs and promotional events: Walking School Bus, Smart Commute Day, Jackson's Safe Routes program were organized and encouraged active commuting and policies and physical projects to improve accessibility. Policy and physical projects: community support and educating decision makers on the benefits of policy and physical projects to support active transportation were made. Schools requested funding for new sidewalks and a study on the financial impact of introducing pedestrian improvements and programs to replace some bus routes, and complete streets resolutions were taken at each level (city, county and metropolitan).

Preparation Promotion Programs Policy Projects

0.321** (for 1 school with 4 measures)

*

**

NA

**

*

*

*


Wen LM et al [33]. Australia.

The intervention was developed within the framework of the Health Promoting Schools Policy. The intervention's strategies included: classroom activities (professional development days for teachers; resources to assist classroom learning; information for students, parents and teachers on preparation for secondary school; pedometer-based walking activities and resources on climate change and the comparative costs of active travel and driving a car), development of school Travel Access Guides to encourage parents to go to school and work by active travel, monthly newsletters for parents and improving environments with local councils (officers assisted in reviewing safety and walkability of the schools and their vicinities and then sought to improve any identified barriers to active and safe travel). The control group received a two-year program on healthy eating at school. The program components were additional funds for teachers to develop food related activities as part of classroom learning.

Preparation Promotion Programs

0.861****

*

***

***

*

*

*

*


Zaccari & Dirkis [34]. Australia.

Pilot WTS project with these objectives: increase the number of children walking to school, to reduce the number of short car trips and to reduce traffic congestion around the school. It is a comprehensive, whole-school approach integrating health-promoting approaches across the curriculum, the school ethos and environment and building on links between the home, school and community. Elements of intervention: 1) Mapping routes to school: classes were provided with a poster-size map and surrounding area for a class exercise and children who walked indicated the route to school; 2) Road safety audit: council audited all key travel routes to school to identify road safety improvements; 3) Banner painting: benefits of walking to school were explored through 36 banners displayed around the school.; 4) Travel diary (explained in transportation measure, table 1); 5) School travel policy: school policy improved health and safety outcomes in students and encourage parents to walk their children to school providing exercise and an opportunity to practice safe pedestrian behavior; 6) Newsletters: 9 weekly newsletters were produced in term 1 of 2001, to raise awareness of the problems generated by driving to school while promoting the benefits of walking; 7) Media: the project team successfully involved the local press in promoting the benefits of walking; and 8) General school assembly: a school assembly dedicated to walking to school was held on the 6 April 2001 to coincide with the inaugural NSW 'walk safely to school day' and the final day of the pilot program.

Preparation Promotion Programs Policy

0.071*

*

**

*

*

*

NA

*


Abbreviations: NA = not applicable; SRTS = Safe Routes to School; WSB = Walking School Bus; WSTSD = Walk Safely to School Day

a ALBD Community Action Model framework. Only if the strategy was mentioned in the paper, was it included.

b Effect size: Cohen's d values were calculated for each study (detail information about calculations is provided in the additional file 2). Effect size was calculated between experimental vs control for changes between pre and posttest, when data were provided. Effect size was calculated between pretest and post-test for the experimental group when there was no control group. Effect size was calculated between experimental and control group for one measure (preferably post-test) if data for only one measure were provided. NA indicates that there were not enough data provided for a calculation. * = trivial; ** = small; *** = moderate; **** = large; ***** = very large

c Quality assessment tool for quantitative studies (McMaster University): Effective public health practice project (EPHPP) (detail information about criteria is provided in the additional file 3). The assessment of "control for confounders" was not applicable (NA) when the study had no a control group. The assessment of "withdrawals and dropouts" was not applicable (NA) when the study had only 1 measure (pre or post). When the assessment of a component was not indicated in the tool, the lower assessment (usually weak) was set. * = weak; ** = moderate; *** = strong.

Chill√≥n et al. International Journal of Behavioral Nutrition and Physical Activity 2011 8:10   doi:10.1186/1479-5868-8-10

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