Environmental Correlates of Safe Walking

Abstract

Source: Rothman L, Buliung R, Macarthur C, et al. Walking and child pedestrian injury: a systematic review of built environment correlates of safe walking. Inj Prev. 2014; 20(1): 41– 49; doi: 10.1136/injuryprev-2012-040701Researchers from the University of Toronto and The Hospital for Sick Children in Toronto performed a systematic review of the literature to explore whether particular characteristics of the built environment have potential both to improve the frequency of walking for children and to reduce their risk of pedestrian injury. The authors reviewed quantitative studies, completed in urban or suburban settings in highly “motorized” countries (high number of vehicles per capita), that examined the effect of features of the built environment and walking frequency and injury in children ≤12 years of age. Specific features of the built environment included child pedestrian population, road design (such as crosswalks or speed bumps), and the diversity of land use (such as the presence of destinations like schools, distance to travel, and the presence of parks or playgrounds). Their systematic review involved 2 independent searches to find studies that investigated the 2 outcomes of interest: walking and pedestrian injury (having found no studies that examined correlates of the built environment on both outcomes simultaneously). After identifying and analyzing 50 eligible “walking” studies and 35 “child pedestrian injury” studies, they compared both specific characteristics of the built environment that were consistently associated with increased or decreased walking and the association of the built environment with increased or decreased risk of pedestrian injury.The only specific features that correlated consistently with both increased walking and decreased injury risk were traffic calming design features (such as speed bumps and roundabouts) and the presence of parks and playgrounds. Some features of the built environment, such as crosswalks and sidewalks, and the proximity of services and facilities, were correlated with increased walking but also with increased injury risk.The authors conclude that these findings suggest a need for a more interdisciplinary approach in the planning and design of urban/suburban environments, such that the promotion of more walking for children can occur in conjunction with appropriate measures to prevent child pedestrian injury.Dr Nelson has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Among US children 4 to 12 years of age, pedestrian injury in motor vehicle traffic causes more than 200 deaths per year, making this a leading cause of injury death.1 Nonfatal pedestrian injuries in the same age range are estimated to account for more than 20,000 emergency department visits annually.2 Such injuries often appear to be associated with travel to school.3At the same time, fatal injury surveillance has shown a decline of more than 50% in child pedestrian death rates just since the 1990s. Research suggests that this decline has largely resulted from steep decreases in walking among children rather than from injury prevention interventions,4 and given the simultaneous rise in US childhood obesity, the decreased injury rates may have been achieved at an undesirable health cost.5 So it is an important question: can we plan and build a road environment that both encourages walking and minimizes the risk of pedestrian injury?These researchers reviewed a prodigious amount of literature, using an interesting dual-systematic-review technique in order to generate a cross-tabulation that allows inference of the likely result if a study were to have investigated the impact of built environment features on both walkability and injury risk together. Strengths include the sheer magnitude of the literature examined and the care with which the investigators extracted findings critically. Limitations cited by the authors involve heterogeneity across studies, for example in ages studied and in locations and travel destinations (though most studies focused on walking to school). They also cite some built environment features such as trails, cul-de-sacs, public transit, and walking network connectivity as warranting further investigation. In addition, the authors of this analysis make no mention of some specific features such as pedestrian bridges or warning signs regarding children at play or in a school zone (which other investigators have discussed).6Researchers long ago recognized that community-based environmental interventions, rather than education of children or drivers alone, would be most likely to help reduce child pedestrian injuries.7 Moreover, some community initiatives might work in concert with or beyond the built environment, such as having adults walk with children to school.8 In any case, the present study provides some convincing support for the value of built environment features, such as traffic calming and playgrounds or park spaces that separate children from traffic, for encouraging children to walk more while also making that walking safer. Pediatricians can and should support this kind of urban design and reclamation for the sake of child health.