An ecological study of built and social environments on active commuting to school

The purpose of this study was to assess the prevalence of active commuting to school (ACS) and the personal, familial, and environmental factors that affect it. The primary goal of the intervention program was to boost physical activity (PA) in children by increasing ACS participation through fun ACS safety promotion. The premise of this ecological study is that the ACS environment affects ACS behavior. A Systematic Pedestrian and Cycling Environmental Scan (SPACES) audit for Mountain West Region neighborhood surveyed physical environmental factors that influence ACS and objectively portrayed an ACS-friendly neighborhood. A pilot study with 16 children and their parents was conducted in the fall of 2017, and a 6-week educational intervention was customized with school committee input, emphasizing inclusivity. Surveys were used to assess ACS and its factors. Although neighborhood assessments raised walkability awareness, there was no increase in ACS during the 6-week study period. The convenience sample was small, and the intervention was short for planned behavior change. Future health educator implications include resuming an ACS intervention with a community-based program for long-term.

AN ECOLOGICAL STUDY OF BUILT AND SOCIAL ENVIRONMENTS ON ACTIVE COMMUTING TO SCHOOL by Allison Marie Godbe A dissertation submitted to the faculty of The University of Utah in partial fulfillment of the requirements for the degree of Doctor of Philosophy Department of Health Promotion and Education The University of Utah August 2018 Copyright © Allison Marie Godbe 2018 All Rights Reserved The University of Utah Graduate School STATEMENT OF DISSERTATION APPROVAL The dissertation of Allison Marie Godbe has been approved by the following supervisory committee members: , Chair Glenn Richardson May 16, 2018 Date Approved , Member David Hawkins May 18, 2018 Date Approved , Member Jakob Jensen May 16, 2018 Date Approved , Member Julia Franklin May 17, 2018 Date Approved , Member Nick Galli May 21, 2018 Date Approved and by the Department/College/School of Mark Williams , Chair/Dean of Health Promotion and Education and by David B. Kieda, Dean of The Graduate School. ABSTRACT The purpose of this study was to assess the prevalence of active commuting to school (ACS) and the personal, familial, and environmental factors that affect it. The primary goal of the intervention program was to boost physical activity (PA) in children by increasing ACS participation through fun ACS safety promotion. The premise of this ecological study is that the ACS environment affects ACS behavior. A Systematic Pedestrian and Cycling Environmental Scan (SPACES) audit for Mountain West Region neighborhood surveyed physical environmental factors that influence ACS and objectively portrayed an ACS-friendly neighborhood. A pilot study with 16 children and their parents was conducted in the fall of 2017, and a 6-week educational intervention was customized with school committee input, emphasizing inclusivity. Surveys were used to assess ACS and its factors. Although neighborhood assessments raised walkability awareness, there was no increase in ACS during the 6-week study period. The convenience sample was small, and the intervention was short for planned behavior change. Future health educator implications include resuming an ACS intervention with a community-based program for long-term. TABLE OF CONTENTS ABSTRACT ....................................................................................................................... iii LIST OF TABLES ............................................................................................................. vi LIST OF FIGURES .......................................................................................................... vii ACKNOWLEDGMENTS ............................................................................................... viii Chapters 1. OVERVIEW ................................................................................................................ 1 Introduction ................................................................................................................ 1 Socio-ecological Theory Model (SEM): A Conceptual Prospective ......................... 3 Physical Activity Alternatives for Children Demonstrate Socio-ecological Theory . 3 After School Programs for Children .......................................................................... 4 Children’s Competitive Sports ................................................................................... 4 Physical Education (PE) Classes ............................................................................... 5 Study Purpose ........................................................................................................... 6 Study Aims ................................................................................................................ 7 Research Questions .................................................................................................... 7 Active Commuting to School Educational Intervention Development ..................... 7 Dissertation ............................................................................................................... 8 References .................................................................................................................. 9 2. ACTIVE COMMUTING TO SCHOOL (ACS): A REVIEW ................................. 14 Abstract .................................................................................................................... 14 Introduction .............................................................................................................. 14 Theoretical Paradigm ............................................................................................... 15 Walking School Bus ................................................................................................ 16 Benefits of Active Commuting to School (ACS) .................................................... 16 Safe Routes to School (SRTS) Programs................................................................. 17 Socio-ecological Theory Model (SEM) ................................................................... 18 The Built Environment (BE) .................................................................................... 19 Active Commuting to School Relevance ................................................................. 21 References ................................................................................................................ 23 3. MOUNTAIN WEST REGION NEIGHBORHOOD ENVIRONMENT ASSESSMENT USING THE SYSTEMATIC PEDESTRIAN AND CYCLING ENVIRONMENTAL SCAN (SPACES) .................................................................. 27 Abstract .................................................................................................................... 27 Introduction .............................................................................................................. 27 Methods.................................................................................................................... 31 Results ...................................................................................................................... 32 Discussion ................................................................................................................ 34 SPACES Audit Relevance ....................................................................................... 35 Reference ................................................................................................................. 36 4. EFFECT OF NEIGHBORHOOD PERCEPTION ON ACTIVE COMMUTING TO SCHOOL AND THE EFFECTIVENESS OF AN ACS EDUCATIONAL INTERVENTION: A PILOT STUDY ...................................................................... 41 Abstract .................................................................................................................... 41 Introduction .............................................................................................................. 41 Methods.................................................................................................................... 42 Study Procedures ..................................................................................................... 43 Quantitative Methods ............................................................................................... 45 Results ...................................................................................................................... 46 Discussion ................................................................................................................ 50 ACS Intervention Relevance.................................................................................... 52 Limitations ............................................................................................................... 53 Future Direction ....................................................................................................... 53 References ................................................................................................................ 55 5. SUMMARY .............................................................................................................. 62 Conclusion and Future Directions ........................................................................... 65 References ................................................................................................................ 68 Appendices A. CONSENT FORMS.............................................................................................. 69 B. QUESTIONNAIRES ............................................................................................ 81 C. ACTIVE COMMUTING TO SCHOOL EDUCATIONAL INTERVENTION 107 v LIST OF TABLES Tables 3.1 Environmental Feature Scores .................................................................................... 39 4.1 Walking Checklist Results .......................................................................................... 58 4.2 Walking in Your Neighborhood (students) Results .................................................... 58 4.3 Demographic Survey Results...................................................................................... 59 4.4 Neighborhood Environmental Walkability Scale (NEWS) Parents Results............... 60 4.5 ACS Evaluation Correlation Matrix Results............................................................... 61 LIST OF FIGURES Figures 1.1: Socio-ecologic theory Model (SEM). ........................................................................ 13 3.1 The Built Environment. .............................................................................................. 39 ACKNOWLEDGMENTS Thank you to everyone who has influenced me, challenged me, and helped me flourish. Reaching the milestone of completing my Ph D degree has been a culmination of all my life experiences. In particular, I want to give recognition to the following individuals who were instrumental in helping me successfully complete my dissertation. Thank you to my committee members: Drs. Glenn Richardson, David Hawkins, Jakob Jensen, Julia Franklin and Nick Galli. I appreciated your encouragement, guidance, and support throughout this research journey. I want to impart my heartfelt gratitude to Dr. David Hawkins. He was my guiding light. His mentorship was extraordinary and it changed my life! Thanks bunches! I wanted to thank my family as well. It took a village to earn a Ph D, and I want to express my gratitude to my mother, father, brothers, and sister-in-laws for their loving support. We did it! I am dedicating this dissertation to two amazing women who I admire! My mother has always believed in me and my dreams. Her love and support has been unequivocal! I am yours and you are mine. I am also extremely grateful to Julie for her passion and diligent efforts! She was remarkable throughout the journey. She always empowered me to strive for excellence and exemplified the ideal of utilizing a positive platform for change. Last but not least, I want to thank Madi, there are no words to describe her loyalty and love! She has been an amazing friend throughout this journey. CHAPTER 1 OVERVIEW Introduction Childhood obesity and physical inactivity have increased dramatically over the past 30 years becoming an American health crisis (Wang, Beydoun, Liang, Caballero, & Kumanyika, 2008). One in 3 children is overweight or obese (Ogden, Carroll, Kit, & Flegal., 2014). The percentage of obese children aged 2-19 years in the United States increased from 5.5% in 1980 to 17.2% in 2014 (Fryar & Ogden, 2016). Children’s overweight is defined as between the 85th and 95th percentiles on the sex-specific Body Mass Index (BMI)-for-age 2000 Center for Disease Control (CDC) growth charts for 220-year-old, while child obesity is defined as above the 95th (Fryar & Ogden, 2016). Body mass index (BMI) is a measure of body mass in relation to height used to measure obesity in adults over 21 (Fryar & Ogden, 2016). Child obesity is associated with increased health risks; its most significant longterm consequence is adult obesity, which is associated with serious health problems including increased morbidity (Taheri, Hassanzadeh-Taheri, Kazemi, Nazari, Gholamreza, & Student Research committee, 2012). Besides psychological repercussions, obese children are more at risk for physical health problems such as heart disease, type 2 diabetes, stroke, and several types of cancer (Office of the Surgeon 2 General, 2010). For children diagnosed with obesity, disease risk factors in adulthood are likely to be more severe as well (Bass & Eneli, 2015). Insufficient physical activity (PA) remains a primary contributor to obesity in children (National Center for Health Statistics, 2012). Three-fourths of children in the United States are currently not meeting PA recommendations (60 minutes of moderateto-vigorous PA daily), putting them at increased risk for future obesity, diabetes, and related chronic illness (National Physical Activity Plan Alliance, November, 2016). The childhood obesity epidemic elicits authorities and parents to search for effective interventions to lower its incident. Healthy lifestyle habits, including physical activity, can lower the risk of obesity and its related diseases (Office of the Surgeon General, 2010). Since most children must travel to school daily, active commuting to school (ACS) is a promising strategy to increase physical activity levels (Larouche & Trudeau, 2010). Active commuting contributes to children’s daily PA and development of healthy lifestyle patterns (Cooper, Jago, Southward, & Page, 2012; Hinckson et al., 2014), and children who walked to school were found to be more active, even outside the walking period (Loucaides & Jago, 2008). Children who practiced ACS consistently were more physically active overall than children who did not (Wong, Faulkner, & Buliung, 2011). Lee, Orenstein, and Richardson (2008) suggested that walking or cycling to school may increase activity levels in two ways: first, commuting itself and second, opportunities for spontaneous play. Timperio et al. (2006) demonstrated that ACS may improve cardiovascular risk factors and psychosocial well-being. Despite the health benefits of active commuting, the 3 percentage of children walking or cycling to school has declined dramatically in the United States from 47.7% in 1969 to 12.7% in 2009 (McDonald, Brown, Marchetti, & Pedroso, 2011). Less than 13% of children ages 5 to 14 usually walk or bicycle to their school (The National Center for Safe Routes to School, 2011). Evidence suggests that children are less likely to actively commute when their parents work (Ziviani, Scott, & Wadley, 2004) and when the active commuting interferes with parents’ work schedules (McMillan, 2007). Socio-ecologic Theory Model: A Conceptual Perspective Besides personal, familial, and societal factors (Sallis et al., 2006), the physical environment influences participation in physical activity (Pikora et al., 2006). See socialecologic theory model (SEM) in Figure 1.1. Physical Activity Alternatives for Children Demonstrate Socio-ecological Theory The shift in interest from vigorous to moderate-intensity physical activities makes walking and cycling favorable choices (Pikora, Giles-Corti, Bull, Jamrozik, & Donovan, 2003). Besides ACS, at-home play, after-school programs, competitive athletics, and school physical education (PE) programs can increase regular PA for children. Many parents are hesitant to allow their children to play outside at home, because they fear for their safety (Institute of Medicine [IOM], 2013). Once, after-school activities meant home play behaviors like riding bikes and playing basketball in the yard (Patterson, 2013). Today’s after-school activities are often tailored to fit into the busy family schedule and occur in places that are deemed safe (Patterson, 2013). Screen (video 4 games) time has replaced physical activity for many youngsters (Carlson et al., 2010), which has contributed to decrease participation in health levels of daily physical activity. After School Programs for Children After-school programs are another easily endorsed strategy to increase children’s physical activity, because they are at school (Beets, Beighle, Erwin, & Huberty, 2009). After-school programs do not detract from time for study during the school day (Beets et al., 2009), offer a safe environment (Huberty, Balluff, Berg, Beighle, & Sun, 2009), and are abundant and available. Transportation appears to be a formidable challenge faced by school-based, after-school programs and can affect the hours of programming and limit accessibility (Grossman, Walker, & Raley, 2001). Trost, Rosenkranz, and Dzewaltowski (2008) found ample room for improvement in after-school programs that existed for making better use of existing time devoted to physical activity. Children’s Competitive Sports Another program children and caregivers turn to for increasing PA is competitive sports. Children’s competitive sports leagues often involve some measure of physical exertion or skill, include regular time for training or practice, and culminate in individual or team competitions. Competitive sports are not only entertaining but can teach participants life skills, including performance preparation, cooperation, and competition. Unfortunately, their cost, transportation, and time commitment can limit accessibility, and overemphasis on elite performance may discourage some children. Longer seasons increase specialization and cost. Travel teams, training gear, skills 5 camps and year-round participation drive up the cost of youth sports. Today, many children hockey players attend spring and summer hockey programs, followed by additional conditioning camps (O’Sullivan, 2014). As enrollment in children's sports leagues becomes less seasonal and more specialized, increased cost effectively prices lower income families out of participation (ParticipACTION, 2015). Spotlighting elite athletic performance in children is another limitation of competitive sports programs. Two-thirds of Americans agree that sports overemphasize winning (U.S. Anti-Doping Association, 2011). Children, aged 5 to 19, reported that the pressure to excel and a corresponding lack of enjoyment was their common reason for dropping out of competitive sports (ParticipACTION, 2015). John O'Sullivan, former NHL player and spokesman for Changing the Game Project pointed out, "We are trying to select out the 'talent' far, far too young” (2013), which fosters increased levels of dissatisfaction. When competition is emphasized above all else, many children quit because they believe they are not good enough (O’Sullivan, 2013). Physical Education (PE) Classes Physical Education (PE) classes in U.S. schools have become the primary societal institution responsible for promoting physical activity in young people (Fernandes, & Sturm, 2011). The goal of physical education is to develop healthy, responsible students who have the skills to work together in groups and participate in a variety of activities that lead to lifelong healthy choices (Utah Elementary Physical Education Core Curriculum, 2007). Society of Health and Physical Educators (SHAPE) America recommends that elementary school children participate in 150 minutes of PA per week 6 (National Association for Sport and Physical Education & American Heart Association, 2010). Although PE classes are the primary form of PA students receive at school, only a handful of states require daily physical education. In Utah, elementary school children are only required to attend one PE class per week (Utah Elementary Physical Education Core Curriculum, 2007). Many schools struggle with time constraints for PE (Fernandes, & Sturm, 2011). Recent demand for schools to improve the academic achievement of children has decreased time for physical education (Trost, Rosenkranz, & Dzewaltowski, 2008). Since the No Child Left Behind Act of 2001, nearly half of school administrators (44 %) reported cutting significant time from physical education classes and recess to increase time spent in reading and mathematics (IOM, 2013). The emphasis on academic achievement in core subjects has unintended consequences for other subjects, such as PE (IOM, 2013). Study Purpose The purpose of this study was to assess the prevalence of active commuting to school (ACS) and to determine personal, familial and environmental factors related to ACS. The primary goal of the intervention program was to increase the number of ACS participants by promoting their enthusiasm and safety. The premise of this ecological study is that the ACS environment affects the ACS behavior. 7 Study Aims The overarching aims of this dissertation are to (1) increase physical activity in a sustainable way in daily childhood routines through an active commuting to school intervention, (2) understand perceived obstacles to ACS, and (3) examine the association of perceived environmental and social factors on the decision to participate in active commuting to school. Research Questions The following research questions are addressed in this study: 1. What are the commuting modes of fourth-grade students? 2. What are the perceived environmental predictors of active commuting to school (ACS)? 3. Is there a relationship between neighborhood walkability (built environment) and ACS? 4. Is there a relationship between parental perception of the neighborhood’s safety and the students ACS behavior? 5. Did the implementation of an ACS educational intervention affect the perception of environmental and student safety? Active Commuting to School Educational Intervention Development The active commuting to school educational intervention was developed based on the parents’ and the school’s personnel input and recommendations. Dr. Hawkins and the researcher were asked to attend a School Community Council (SCC) meeting on April 8 20, 2017. The ACS program’s learning objective and format were delineated during that time, and the SCC suggestions were given serious consideration in the study design and implementation. Dissertation This dissertation follows the three-article format and includes three publishable articles. The first article, presented in Chapter 2 is a review of active commuting to school (ACS) literature and will be submitted to The International Journal of Health Promotion and Education. The second article, presented in Chapter 3, describes a Mountain West Regional School environmental assessment utilizing the Systematic Pedestrian and Cycling Environmental Scan (SPACES). It measures the attributes around students’ homes and route(s) to school and will be submitted as original research to the International Journal of Health Promotion and Education. The third article, presented in Chapter 4, includes data about ACS prevalence and ACS perceptions before and after an ACS educational intervention using the Walking Checklist, the Neighborhood Environment Walking Survey (NEWS), the Student ACS Program Evaluation, and the Parent ACS Program Evaluation. This educational program aims to improve students' active commuting skills and awareness as well as to increase their safety and will be submitted as original research to the International Journal of Health Promotion and Educations. Finally, Chapter 5 summarizes study results and offers direction for future ACS research and programs. 9 References Bass, R. & Eneli, I. (2015). Severe childhood obesity: An under-recognized and growing health problem. Postgrad Medical Journal, 91(1081), 639-45. Beets, M. W., Beighle, A., Erwin, H. E., & Huberty, J. L. (2009) After-School Program impact on physical activity and fitness: A meta-analysis. American Journal of Preventive Medicine, 36(6):527-537. Carlson, S., Fulton, J., Lee, S., Foley, J., Heitzler, C., & Huhman, M. (2010). Influence of limit-setting and participation in physical activity on youth screen time. Pediatrics, 126(1), e89-e96. Cooper, A. R., Jago, R., Southward, E. F., & Page, A. S. (2012). Active travel and physical activity across the school transition: The PEACH project. Medicine & Science in Sports & Exercise, 44(10), 1890-1897. Fernandes, M. & Sturm, R. (2011). The role of school physical activity programs in child body mass trajectory. Journal of Physical Activity and Health. 8(2), 174–181. Fryar, C. D. & Ogden, C. L., (2016). Prevalence of overweight and obesity among children and adolescents aged 2-19 years: United States, 1963-1965 through 2013-2014. National Center for Health Statistics Data, Health-E-Stats. http://www.cdc.gov/nchs/data/hestat/obesity_child_13_14.htm. Grossman, J. B., Walker, K. & Raley, R. (2001). Challenges and opportunities in afterschool programs: Lessons for policymakers and funders. Philadelphia: Public/Private Ventures.: www.ppv.org/ppv/publications/assets/120_publication.pdf. Hinckson, E. A., McGrath, L., Hopkins, W., Oliver, M., Badland, H., Mavoa, S., Witten, K.. et al., (2014). Distance to school is associated with sedentary time in children: Fndings from the URBAN study. Frontiers in Public Health, 2:151. Huberty, J. L., Balluff, M., Berg, K., Beighle, A., & Sun, J. (2009). Club possible: Feasibility of an after school physical activity program for children ages 5–12 years. Journal of Parks and Recreation Administration, 27(2). 97-111. Institute of Medicine (IOM), (2013). Educating the student body: Taking physical activity and physical education to school. Kohl, H. W. & Cook, H. D., Editors. The National Academic Press: Washington, D.C. Larouche, R. & Trudeau F. (2010). Active commuting: its impact on physical activity and health, and its main determinants. Science & Sports, 25(5), 227—237. Lee, M., Orenstein, M., & Richardson, M. (2008). Systematic review of active 10 commuting to school and children’s physical activity and weight. Journal of Physical Activity and Health, 5(6), 930–49. Loucaides, C.A., & Jago, R. (2008). Differences in physical activity by gender, weight status and travel mode to school in Cypriot children. Preventive Medicine, 47(1), 107-111. McDonald, N. C., Brown, A. L., Marchetti, L. M., & Pedroso, M. S. (2011). U.S. school travel, an assessment of trends. American Journal of Preventive Medicine, 41(2), 146–51. McMillan, T. E. (2007). The relative influence of urban form on a child’s travel mode to school. Transportation Research Part A 2007;41(1):69-79. National Association for Sport and Physical Education & American Heart Association. (2010). 2010 Shape of the nation report: Status of physical education in the USA. Reston, VA: National Association for Sport and Physical Education. National Center for Health Statistics, (2012). Retrieved from https://www.cdc.gov/nchs/index.htm. Office of the Surgeon General (US). (2010). The Surgeon General's vision for a healthy and fit nation. Rockville, MD, Office of the Surgeon General (US). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK44660/. National Physical Activity Plan Alliance (2016). 2016 United States Report Card on Physical Activity for Children and Youth. Colombia, SC. Retrieved from http://physicalactivityplan.org/projects/reportcard.html Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of childhood and adult obesity in the United States, 2011-2012. Journal of the American Medical Association, 311(8), 806-814. O' Sullivan, J. (2014). Is it wise to specialize? What every parent needs to know about early specialization in sports and its effect upon your child’s athletic performance. Seattle, WA: Amazon Digital Services, Inc. ParticipACTION, (2015). The biggest risk is keeping kids indoors. The 2015 ParticipACTION Report Card on Physical Activity for Children and Youth. Toronto, ParticipACTION. http://www.participaction.com/report-card2015/report-card/, 18-19. Patterson, J. (2013). Many schools cutting back on physical education. Las Vegas Review-Journal.Retreived from https://www.reviewjournal.com/news/education/many-schools-cutting-back-onphysical-education/ 11 Pikora, T. J., Giles-Corti, B., Bull, F. C., Jamrozik, K., & Donovan, R.J. (2003). Developing a framework for assessment of the environment determinants of walking and cycling. Social Science Medicine, 56(8), 1693-703. Pikora, T. J., Giles-Corti, B., Knuiman, M. W., Bull, F. C., Jamrozik, K., & Donovan, R. J. (2006). Neighborhood environmental factors correlated with walking near home: Using SPACES. Medicine and Science in Sports and Exercise. 38(4), 708– 714. Sallis, J. F., Cervero, R. B., Ascher, W., Henderson, K. A., Kraft, M. K., & Kerr, J. (2006). An ecological approach to creating active commuting communities. Annual Review of Public Health, 27, 297-322. Taheri, Hassanzadeh-Taheri, Kazemi, Nazari, Gholamreza, & Student Research committee (2012). Prevalence of overweight and obesity in preschool children (25-year-old) in Birjand, Iran. BMC Psychology, 5, 529. The National Center for Safe Routes to School, (2011). The Decline of Walking and Bicycling. Retreived from http://guide.saferoutesinfo.org/introduction/the_decline_of_walking_and_bicyclin g.cfm Timperio, A., Ball, K., Salmon, J., Roberts, R., Geo, M., Giles-Corti, B., Simmons, D., Baur, L. A., & Crawford, D. (2006). Personal, family, social, and environmental correlates of active commuting to school. American Journal of Preventive Medicine, (30)1. Trost, S. G., Rosenkranz, R. R., & Dzewaltowski, D. (2008). Physical activity levels among children attending after-school programs. Medicine and Science in Sports and Exercise, 40, 622–9. U.S. Anti-Doping Agency (2011). What Sports Mean in America: a study of sport’s role in society. Discovery Education. Silver Spring, MD, 8,15. Retreived from http://www.truesport.org/library/documents/about/what_sport_means_in_america/ what_sport_means_in_america.pdf. Utah Elementary Physical Education Core Curriculum (2007). Wang, Y., Beydoun, M. A., Liang, L., Caballero, B. and Kumanyika, S. K. (2008), Will All Americans Become Overweight or Obese? Estimating the Progression and Cost of the US Obesity Epidemic. Obesity, 16: 2323-2330. Wong, B. Y., Faulkner, G., & Buliung, R. (2011). GIS measures environmental correlates of active school transport: A systematic review of 14 studies. International Journal of Behavioral Nutrition and Physical Activity,18:39. 12 Ziviani, J., Scott, J., & Wadley, D. (2004). Walking to school: Incidental physical activity in the daily occupations of Australian children. Occupational Therapy International 2004;11(1):1-11. 13 Figure 1.1: Socio-ecologic theory Model (SEM) portrays how different environments effect individual behavior. CHAPTER 2 ACTIVE COMMUTING TO SCHOOL (ACS): A REVIEW Abstract This literature review reinforces the premise that active commuting to school (ACS) may increase children’s daily physical activity (PA) to decrease obesity risks. Current literature supports children’s ACS programming ideals and describes the socialecological theory that establishes a helpful framework for further studying and promoting ACS. However, current literature is less sufficient in standardized ACS study instruments and implementation data. Introduction Worldwide, the prevalence of overweight and obesity among children and adolescents aged 5-19 has risen dramatically from just 4% in 1975 to just over 18% in 2016, affecting 340 million children (World Health Organization, 2017). Active commuting to school (ACS) can be an important regular source of physical activity (PA) for children and provide an opportunity to incorporate frequent PA in daily living (Gordon-Larsen et al., 2009), contributing to the prevention of excess weight gain (Pabayo et al., 2012). Tudor-Locke, Ainsworth and Popkin described the commute to and from school as “an overlooked form of children’s physical activity” (2001, p.309) that 15 has been largely neglected in surveys of PA. Literary findings prompt international government agencies to promote walking, cycling and public transport to tackle the public health concerns of physical inactivity (Craig, Cameron, Russell, & Beaulieu, 2009). It is noteworthy that many of the articles cited here demonstrate international, mostly English-speaking, collaboration. Theoretical Paradigm Stokols (1996) introduced his Social-ecological model of health promotion (SEM) to explain the usefulness of social-ecological theory in health behavior research. The ecological model (social-ecologic theory) is based on the principle that health behaviors are influenced by multiple societal levels, including individual, social and cultural groups, and the natural and built environment (Sallis, Owen, & Fisher, 2008). SEM provides a conceptual basis for studying the environmental correlates of physical activity (Sallis, Cervero, Ascher, Henderson, Kraft, & Kerr, 2006). The environment largely controls or sets limits on the behavior that occurs within it, and SEM provides a theoretical underpinning for interventions for health-enhancing practices (Giles-Corti et al., 2005; Glanz, Rimer, & Vizwanath (eds. 2008); Green, Richard, & Potvin, 1996; Oyeyemi et al., 2013; Saelens, & Handy, 2008). While international demand is high for increasing ACS, research on methodology is lagging. The current federal program (SAFETEA-LU), which is expected to provide funds to build (ACS) infrastructure and help develop effective (ACS) programs, could provide a unique opportunity for pre-implementation and post-implementation data collection and identification of successful strategies. The key is to develop standardized instruments and 16 variable definitions to allow for comparative studies, provide a repository for the data (e.g., a secure Web site hosted by an academic institution), and develop a reporting platform that will make lessons learned available as quickly as possible. Walking School Bus Mendoza et al. (2011) reported that a randomized controlled trial of a Walking School Bus (WSB) program in Texas significantly increased daily moderate-to-vigorous PA for children who participated in the program. WSB programs are walking cohorts led by parents and responsible-adults who walk neighborhood children to school and back. In addition to the opportunity for PA, WSBs allow adults to regularly model and teach pedestrian safety (Mendoza et al., 2011). Benefits of Active Commuting to School (ACS) Roth, Millett, and Mindell (2012) assessed ACS’s contribution to children's overall PA levels using data from the Health Survey for England. They found that children who walked or cycled to school were more active overall and less likely to be obese (Roth et al., 2012). Study results showed that 64% of children who walked and the 3% of those who cycled to and from school were more active than the 33% who did neither (Roth et al., 2012). ACS is further substantiated by Faulkner, Buliung, Flora, and Fusco (2009), who showed that Canadian children who actively commuted to school had healthier body weights. Eleven of thirteen studies provided evidence that children who actively commuted to school (ACS) were more physically active than those who utilized 17 motorized transportation (Cooper et al., 2006). Faulkner et al. (2009) found that six of ten studies showed a greater volume of PA in active commuters, measured by accelerometers in counts per minute, compared to passive commuters. Thus, active commuters amassed more minutes of moderate-to-vigorous physical activity (MVPA) than passive commuters (Faulkner et al., 2009). In England, Voss and Sandercock (2010) showed that walkers and cyclists were more likely than passive transport users to be classified as fit using recognized cut points; this suggests those who walked and cycled to school may be at reduced risk for developing chronic diseases in adulthood. Such findings prompt international government agencies to promote walking, cycling and public transport to tackle the public health concerns of physical inactivity (Craig, Cameron, Russell, & Beaulieu, 2009). Safe Routes to School (SRTS) Programs To increase ACS in the United States in 2005, the Federal Transportation Bill created the Safe Routes to School (SRTS) program (Boarnet, Anderson, Day, McMillan, & Alfonzo, 2005). The SRTS program encourages active commuting to schools by offering helpful resources for identifying safe routes, and promoting ACS fun and safety (Stewart, Vernez-Moudon, & Claybrooke, 2012). SRTS programs encourage use of the socioeconomic approach through the “five E’s”: engineering, enforcement, education, encouragement, and evaluation (Stewart et al., 2012). In Marin County (California), one of the first SRTS program student transportation surveys showed an increase of 64 % in walking and 114% in biking from fall 2000 to spring 2002 (Staunton, Hubsmith, & Kallins, 2003). 18 McDonald, Yang, Abbott, and Bullock (2013) measured the impact of Eugene, Oregon's SRTS program from 2007 to 2011 at 14 schools, both with and without SRTS programs. It showed increases in walking and biking of 5-20% (McDonald et al., 2013). Education and encouragement programs were associated with a 5% increase (McDonald et al., 2013). DiMaggio, Frangos, and Li (2016) investigated the impact of the SRTS program on injuries in a nationwide sample. They reported an approximate 23% reduction in pedestrian/cyclist injury and a 20% reduction in pedestrian and cyclist fatality where Safe Routes programs were in place. They concluded that SRTS improved traffic safety for school-age children in the United States (DiMaggio et al., 2016). Socio-ecological Model (SEM) While international studies varied with instrumentation and implementation, SEM allowed for the scrutinization of ACS factors. Acknowledgement of the common catalysts and barriers to active commuting help individuals, families, neighborhoods, and community constructs to facilitate active commuting. Stewart et al. (2012) used mixed method research to explore the reasons behind parents’ and children’s use and nonuse of ACS. Eight common factors they identified include the following: distance to school, parental fear of traffic and crime, family schedule constraints, weather, neighborhood, school characteristics, and family resources. Ahlport, Linnan, Vaughn, Evenson, and Ward (2008) further explored intra- and interpersonal socio-environmental components of ACS. They noted parental and child concerns for safety (e.g., fear of a child walking alone) affected ACS. They suggested 19 that the parent’s and the child’s relationship with the social environment influences the (intra)personal choice to participate in ACS. Their results support findings that families operate as homeostatic, but modifiable, systems play an important role in the development of children’s health behaviors and affect children’s physical activity behaviors (Sallis, Prochaska, &Taylor, 2000). Pont, Ziviani, Wadley, Bennett, and Abbott (2009) identified modifiable socioenvironmental factors of ACS to include the following: gender and age of the child, home environmental characteristics (including distance from home to school), perceived social neighborhood characteristics (safety), and perceived physical neighborhood characteristics (quality of sidewalks and bike lanes, presence of greenery, and traffic situations). Safe Routes to School (Pedestrian and Bicycle Information Center [PBIC], SRTS Guide. http;//guide.saferoute.org) acknowledged SEM, noting that “active commuting helps both parents and children build a sense of neighborhood. When children walk to school, parents are more likely to be involved at school and/or in the community.” The Built Environment (BE) The Built Environment (BE) is an important concept in ACS, both for parents and children. Over the past two decades, the important role that the BE plays in encouraging or inhibiting physical activity has been illustrated (Centers for Disease Control and Prevention 2011). Unfortunately, many communities are designed in ways that make ACS difficult. For many children, safe routes for walking or biking to school may not exist. The presence and quality of walking paths, bike lanes, and road safety have a 20 significant impact on active transportation in youth (Pont et al., 2009). A key benchmark for whether a child will be permitted to participate in ACS is the parental assessment of how safe the neighborhood is in terms of traffic and personal safety (Giles-Corti, Kelty, Zubrick, & Villanueva, 2009). Oluyomi et al. (2014) examined the relationships between ACS and measures of safety concerns and found that students were more likely to walk to school if their parents reported favorable perceptions about sidewalk availability, sidewalk maintenance, and road-crossing safety. Children develop independent mobility by around age nine, but neighborhood design, particularly in terms of proximity and connectivity to local destinations (like school), is a crucial determinant for parent approval of active commuting (Giles-Corti, et al., 2009). McDonald and Aalborg (2009) conducted a telephone interview study of 403 parents with children aged 10 to 14 in the San Francisco Bay Area, focusing on the walkable environment. Parents living within two miles of the school, who drove their children, did so for two reasons: safety and/or convenience; safety responses included stranger danger or traffic concerns (McDonald & Aalborg, 2009). National statistics demonstrate that traffic concerns are justifiable. In 2011, pedestrian events accounted for nearly 20% of traffic injury fatalities in children, aged 5 to 9 years, compared to 5% in adults (National Highway Traffic Safety Administration, 2013). Distance to school is a barrier to ACS consistently reported by parents (Heelan et al., 2005). Distance directly affects the travel time each mode requires, and parents often chose the mode of shortest duration (Faulkner, Richichi, Buliung, Fusco, & Moola, 2010). Nelson, Foley, O'Gorman, Moyna, and Woods (2008) found that the majority of walkers in their Scottish study lived within 1.5 miles of school and cyclists within 2.5 21 miles; those who perceived distance as a barrier to ACS lived greater than 2.5 miles from school. Ducheyne, De Bourdeaudhuij, Spittaels, and Cardon (2012) examined cycling to school among Belgian 10 to 12-year-olds, using an ecological framework. Their results suggest that promoting a positive attitude among parents (i.e., in favor of cycling to school) and teaching basic cycling skills can be effective strategies for promoting cycling ACS (Ducheyne et al., 2012). Consistent findings have emerged that people who live in Seattle neighborhoods with supportive BE features like street connectivity, good aesthetics, access to destinations, and availability of facilities are more physically active than those living in neighborhoods with unsupportive environmental features (Saelens, & Handy, 2008). Active Commuting to School Relevance Childhood obesity has reached epidemic portion and the condition increases health risks; its most significant long-term consequence is adult obesity. Insufficient physical activity is a primary contributor to obesity. One motivation for using active commuting is decreasing rates of obesity among children. ACS can be a significant source of daily physical activity for children, thus it is considered a feasible approach to addressing the obesity challenge. The current literature review shows that different factors influence ACS participation. Acknowledgement of the common catalysts and barriers to active commuting may help individuals, families, and communities successfully facilitate active commuting. Catalysts to ACS include promoting a positive attitude among parents, 22 teaching basic safety skills, and designing neighborhoods with supportive built environments (i.e., street lights, prominently placed visual surveillance, school crossing and traffic lights, and well-maintained tree-lined sidewalks). Barriers include distance, crime perception, physical inability to ACS, and limited time for an ACS intervention that is community-sustainable and consistent for individual behavior change support. The literature review in this chapter includes a range of studies from numerous countries. This scholarship reflects not only the worldwide impact of child obesity, but also demonstrates the broad research interest and scope of data now available on the subject. A small ACS study will not necessarily add to the existing SEM-based literature concerning factors associated with ACS. However, it may contribute to a better, more prepared understanding of ACS where it concerns the needs of a small US school or population and add to future research where standardized data collection is utilized. 23 References Ahlport, K. N., Linnan, L., Vaughn, A., Evenson, K. R., & Ward, D. S. (2008). Barriers to and facilitators of walking and bicycling to school: Formative results from the non-motorized travel study. Health Education Behavior, 35(2), 221-44. Boarnet, M. G., Anderson, C. L., Day, K., McMillan, T., & Alfonzo, M. (2005). Evaluation of the California safe routes to school legislation: Urban form changes and children’s active transportation to school. American Journal of Preventive Medicine, 28(2S2), 34–40. Centers for Disease Control and Prevention. 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Individual, social and physical environmental correlates of ‘never’ and ‘always’ cycling to school among 10 to 12-year-old children living within a 3.0 km distance from school. International Journal of Behavioral Nutrition and Physical Activity, 9, 142. Faulkner, G. E., Buliung, R. N., Flora, P. K., & Fusco, C. (2009). Active school transport, physical activity levels and body weight of children and youth: A systematic review. Preventive Medicine, 48(1), 3–8. Faulkner, G. E., Richichi, V., Buliung, R. N., Fusco, C., & Moola, F. (2010). What’s the quickest and easiest: Parental decision making about school trip mode. International Journal of Behavioral Nutrition and Physical Activity, 7(62). Giles-Corti, B., Kelty, S., Zubrick S, & Villanueva K. (2009). Encouraging active transport and physical activity in children and adolescents: How important is the built environment? Sports Medicine, 39(12), 995-100. 24 Glanz, K., Rimer, B. K., & Viswanath, K. (eds.). (2008). Health behavior and health education: Theory, research, and practice 4th Edition. Jossey-Bass. San Francisco. Gordon-Larsen P., Boone-Heinonen, J., Sidney S., Sternfeld, B., Jacobs, D. R., & Lewis, C. E.(2009). Active commuting and cardiovascular disease risk: The CARDIA study. Archives of Internal Medicine, 169(13), 1216-23. Green, L. W., Richard, L. & Potvin, L. (1996). Ecological foundations of health promotion. American Journal of Health Promotion, 10, 270–81. Heelan, K. A., Donnelly, J. E., Jacobsen, D. J., Mayo, M. S., Wasburn, R., & Greene, L. (2005). Active commuting to and from school and BMI in elementary school children- preliminary data. Child Care Health Development, 31(3), 341-9. National Highway Traffic Safety Administration, (2013) Traffic Safety Facts 2011 Data—Children. Washington, DC: National Highway Traffic Safety Administration. DOT HS 811 767. Retreived from http://www-nrd. nhtsa.dot.gov/Pubs/811767.pdf. McDonald, N. C., & Aalborg, A. E. (2009). 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In this chapter, a Systematic Pedestrian and Cycling Environmental Scan (SPACES) audit was used to measure the physical environmental factors that might influence walking and biking to school. In order to gain a repository for ACS data, standardized instruments and variable definitions are necessary for comparative studies. In this study, the SPACES survey tool was instrumental in collecting and developing this data. Introduction In 2015, 5,376 pedestrians and 818 bicyclists were killed in accidents involving motor vehicles (National Highway Traffic Safety Administration, Traffic Safety Facts). 28 These two modes (i.e., walking and bicycling) accounted for 17.7% of the 35,092 total U.S. traffic fatalities that year. Pedestrian fatalities rose by 12% and bike fatalities rose by 6% from 2006-2015. Estimated pedestrian and bike injuries rose 14.8% and 2.3% from 2006 – 2015 (National Highway Traffic Safety Administration, Traffic Safety Facts). According to the 2012 National Survey on Bicyclist and Pedestrian Attitudes and Behaviors, poor quality facilities are the leading cause of pedestrian injury (Schroeder & Wilbur, 2013). The National Highway Traffic Safety Administration (NHTSA) reported that 26% of pedestrian accidents and 20% of bicycle accidents took place between 6 and 9 pm (dusk). This survey (2012) reported that the six leading causes of pedestrian injury include the following: tripped and fell on uneven sidewalk crack (24%), tripped and fell on other surface; (17%), hit by car (12%), wildlife and pets involved (6%), tripped on a stone (5%), and stepped in a hole (5%). The six leading causes of cycling injury include the following: hit by car (29%), fall (17%), street not in good repair (13%), rider error (13%), collision (7%), and animal ran out (4%); Schroeder, & Wilbur, 2013). The built environment (BE) has been shown to play an important role in encouraging or inhibiting physical activity (Centers for Disease Control and Prevention, 2011). “Walkable neighborhoods,” “socio-physical structures,” “environmental designs,” and “safe pedestrian networks” (see Figure 3.1) affect the physical activity individuals engage in for health (Carver Timperio, Hesketh, & Crawford, 2010; McGrath et al., 2016). More precisely, BE may promote or constrain children’s active commuting (GilesCorti, Timperio, Bull, & Pikora, 2005; McGrath et al., 2016). Environmental factors that have an effect on physical activity include 29 connectivity, population density (Braza, Shoemaker, & Seeley, 2004), land use mix, and overall neighborhood design (McCormack & Shiell, 2011). Neighborhoods with more green spaces and attractive streets were positively associated with children’s activity (McGrath et al., 2016). Specific features of the built environment including street and sidewalk upkeep, traffic control devices (Boarnet, Anderson, Day, McMillan, & Alfonzo, 2005), lighting, aesthetics, and destinations seem to encourage physical activity in children (Corder, Sallis, Crespo, & Elder, 2011; Leslie & Cerin, 2008; Pikora et al., 2005). Accounting for individual attributes of the BE that constrain or promote children’s walking is important for promoting ACS (Giles-Corti et al., 2005), and well-maintained neighborhoods have proven to be powerful motivators overall for PA (Hoehner et al., 2005). A key benchmark for whether a child will be permitted to participate in ACS is the parental assessment of neighborhood safety, including both traffic and personal safety factors (Giles-Corti, Kelty, Zubrick, & Villanueva, 2009). Oluyomi1, Lee, Nehme, Dowdy, Ory, and Hoelscher (2014) performed a parental safety assessment and correlated it with children’s participation in ACS; they found students were more likely to walk to school if their parent(s) reported favorable perceptions about the neighborhood. Among the most often cited BE factors, parents mentioned higher sidewalk availability, well-maintained sidewalks, and safe road crossings. Well-designed and safe pedestrian networks in environments may ease parental concerns and, therefore, encourage children’s independent neighborhood active commuting (Carver et al., 2010). Conversely, the presence of multiple road-crossings to reach public play areas and/or the absence of traffic lights or designated crosswalks in a 30 neighborhood were found to be negatively associated with parental attitudes toward regular independent commuting for children (Saksvig, Catellier, & Pfeiffer, et al. 2007; Timperio, Crawford, Telford, & Salmon, 2004; Timperio et al., 2006). Environmental evaluations are used to determine how a specific physical environment supports or limits physical activity and other healthy lifestyle interests. A variety of assessment tools exist to evaluate the physical characteristics of communities and neighborhoods: Active Commuting Route Environment Scale (ACRES; Wahlgren, Stigell, & Schantz, 2010), Community Health Assessment in Rural Towns (iCHART; Seguin, Sririam, Connor, & Totta, 2017), Built Environment Assessment Tool (BEAT, [NYC]; Haapio & Vitaniem, 2008), and Systemic Pedestrian and Cycling Environmental Scan (SPACES; McGrath et al., 2016). McGrath et al. (2016) investigated the association between objective measurement of the environment and children’s physical activity with the SPACES instrument. SPACES is an observational audit tool that measures physical neighborhood environmental factors (type of buildings, paths for walking and cycling, condition of roads, crossing aids, presence of streetlights, garden maintenance, cleanliness, etc.) that influence walking and cycling (Pikora, Jamrozik, Knuiman, GilesCorti, & Donovan, 2002). This tool was chosen to assess the natural and built environment of a suburban Mountain West Region neighborhood to determine what support and/or barriers it offers to ACS. SPACES is one of the first environmental tools developed to measure features of the built environment associated with physical activity (Pikora et al., 2002). Pikora et al. (2006) examined correlations between physical environmental factors and self-reported walking for transport near home. They assessed local environments for walking 31 suitability using the SPACES tool (Pikora et al., 2006). The findings suggest that neighborhoods with attractive pedestrian facilities and local destinations (such as stores and public transport) are more likely to be associated with walking near home (Pikora et al., 2006). The SPACES audit tool also collects information about street width, sidewalks, traffic volume, lighting, aesthetics, parks and shops, and various other factors that might be linked to active commuting. In this ecological study of a neighborhood, environmental information will be valuable for the assessment of the physical environment’s effect on ACS and promoting safe active commuting. Methods An audit tool that links the built environment to physical activity is critical to the success of this ecological study. The neighborhood at the center of this research was selected based on its proximity to the researcher’s home. The researcher uses active commuting daily, biking to and from all destinations. Although this allowed the researcher to model ACS behavior for students, it effectively limited the number of neighborhoods that could be used in the study (restricting the pool to ones reachable by bicycle). The neighborhood within a 1-mile radius of a Mountain West Region Elementary School was audited using SPACES to evaluate whether the neighborhood infrastructure supports or impedes walking and/or cycling along the street network. The BE of a residential community has been shown to be associated with the decision to participate in ACS. The audit assessed 112 street segments. Street maps were developed with starting 32 points and coded street segments. A street segment is defined as the section of road between two intersections. Each segment was given a unique number. Thirty-seven items including types of buildings, destinations, assessment of paths and road, aesthetics, safety, and pedestrian and cycling infrastructure were assessed in the audit. In order to conduct an effective SPACES audit, each segment was walked once in both directions while observing both sides of the street. Information was recorded directly onto an audit form. To reduce subjectivity, the detailed SPACES’ instructional guidebook was utilized, focusing the auditor’s attention on specific description of the street-level features. The investigator audited some areas twice (segments 7, 20 and 47 were randomly selected) to act as a quality control measure. The second audit showed the same results as the first audit, which verified auditor reliability. The SPACES instrument provides a reliable, practical, and easy-to-use method for collecting detailed “street-level” data on physical environmental factors that may influence walking in local neighborhoods (Pikora et al., 2002). Pikora et al. (2002) established suitable intra- and interrater reliability of the tool in an Australian setting. Results The audited physical attributes of the neighborhood were divided into four feature categories: function, safety, aesthetic, and destination. Functional features described the quality of neighborhood paths and streets, including path location, type of surface material, and path maintenance. A descriptive analysis addressed each feature by calculating the mean and standard deviation. The mode (most frequently occurring score in the data analysis) was used to characterize the predominant neighborhood features. 33 The mean is a measure of central tendency (average score) and was not influenced by any extreme scores. The mode and mean are the two analyses that closely resembled one another. The top of Table 3.1 lists the functional features. Predominant features include the following: path location more than 3-meters from the road (Mode = 49.55%), concrete slabs path surface (Mode = 93.75%), and good path maintenance (Mode = 87.50 %). These features exemplify the presence of well-maintained sidewalks, which has been correlated with walkability (Pikora et al., 2006). Safety features included both elements of personal and traffic safety. The personal safety features included lights over paths (Mode = 98.00%) and surveillance (Mode = 84.80%). The traffic safety features included school crossings (Mode = 10.70%) and traffic lights (Mode = 91.10%). The audit showed a high prevalence of traffic control devices, which correlated with increased walkability (Pikora et al., 2006). Aesthetic features accounted for in the SPACES audit reflect whether the physical environment is pleasant for walking and incorporated trees (Mode = 97.30%), gardens (Mode = 76.80%), and cleanliness (Mode = 71.40%). The SPACES audit also includes the structural features of road conditions and architectural structures. The audit showed that street conditions were good in the neighborhood (Mode = 95.50%) and the predominant architectural features were houses (Mode = 82.50%). The final feature assessed was neighborhood destinations, or accessibility to community amenities (Mode = 43.70%). A number of items had either high or low mean scores (mean > 0.75 or < 0.29) and low SD (< 0.26), indicating that there was little variation for neighborhood destination across the neighborhood. A larger study with more 34 participation and/or a greater distance from the school may have shown higher variation. The analysis showed that favorable neighborhood walkability factors were present in the area, and this Mountain West Region School neighborhood is conducive to active commuting. Discussion The Mountain West Region possesses many active-commuter friendly attributes such as an elevated prevalence of traffic control devices and lights, and pleasant neighborhood aesthetics (Corder, Sallis, Crespo, & Elder, 2011; Leslie & Cerin, 2008; Pikora et al., 2005). The SPACES data collected revealed the presence of wellmaintained sidewalks and streets, which have been correlated with increased walking as well (Pikora et al., 2006). For traffic safety, street lights had been installed over all neighborhood paths and roadways, and visual surveillance was prominently placed. Other neighborhood traffic safety features include school crossings and several traffic lights. The aesthetic attributes of the neighborhood exhibited a pleasant and clean physical environment filled with trees and gardens. The SPACES instrument provided a reliable and easy-to-use method for collecting detailed data on the physical environment, focusing explicitly on BE factors that have the potential to influence walking and cycling in local neighborhoods (Pikora et al., 2002). One significant advantage of the SPACES instrument was its objectivity compared to participant-reported walkability assessments. Additionally, it can be used with or without having to be integrated into another assessment instrument. 35 Although the SPACES audit was time consuming and data was costly to collect, enter, and analyze, the tool provided a highly detailed measurement of the neighborhood’s built environment. SPACES Audit Relevance Where we live, learn, and play affects how active we choose to be (Ding, Sallis, Kerr, Lee, & Rosenberg, 2011). The built environment plays a vital role in supporting or inhibiting children’s physical activity. Audit tools are useful for exploring the neighborhood environment and its association with active commuting. An objective measure of neighborhood walkability attributes is important because it can reveal the individual factors of the built environment that constrain or promote children’s walking (Giles-Corti, et al., 2005). Well-maintained neighborhoods have proven to be powerful overall motivators for physical activity (Hoehner, Ramirez, Elliott, Handy, Brownson, & Ross, 2005). In this study, the SPACES audit was a useful tool for measuring the walking and cycling environment of a Mountain West Region. Standardization of environmental audits for physical activity like active commuting is in its early stages. Nevertheless, the development of reliable environmental audit tools can help us better understand the role of the BE on physical activity and ACS. 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Preventive Medicine Report, 7, 169175. Timperio, A., Ball, K., Salmon, J., Roberts, R., Geo, M., Giles-Corti, B., Simmons, D., Baur, L. A., & Crawford, D. (2006). Personal, family, social, and environmental correlates of active commuting to school. American Journal of Preventive Medicine, (30)1. 38 Timperio, A., Crawford, D., Telford, A., & Salmon, J. (2004). Perceptions about the local neighborhood and walking and cycling among children. Preventive Medicine, 38, 39–47. Wahlgren, L., Stigell, E., & Shantz, P. (2010). The active commuting route environment scale (ACRES): Development and evaluation. International Journal of Behavioral Nutrition and Physical Activity, 7(58). 39 Figure 3.1 The Built Environment Table 3.1 Environmental Features Scores: the analysis showed that the neighborhood is conducive to active commuting Environmental Features FUNCTIONAL Walking Surface (location) Next to road Within 1 meter of the road Between 1-2 meters of the road Between 2-3 meters of the road More than 3 meters from the road Path Surface – Concretes Slabs Path Maintenance Moderate Good Path Continuity Street Width – Number of Lanes 1 Lane 2 or 3 Lanes 4 or 5 Lanes N 112 Mode Mean Std. Deviation 8.45% (8) 12.05% (14) 5.85% (6) 24.55% (27) .0848 .27581 .1205 .0580 .31655 .23002 .2455 .42973 49.55% (55) 93.75% (105) .4955 .49545 .9375 .23370 11.6% (13) 87.5 % (98) 100% .1161 .32175 .8795 1.0000 .32359 .00000 .0089 .00000 .5714 .09449 .3839 .48853 <1.0% (1) 57.1% (64) 38.4% (43) 40 Table 3.1 Continued Environmental Features 6 Lanes SAFETY Personal Lights over Path N Street Condition Moderate Good Architecture Transportation Houses Offices Convenience Stores Industrial Education Other Services Nature Std. Deviation .49710 .9554 .20745 .9821 .13303 1.1518 .36043 .0357 .1071 .18641 .31068 .8036 .39908 97.3% (109) 71.4% (80) 76.8% (86) 1.0357 2.2679 .22971 .46464 1.2500 .47458 4.5% (5) 95.5% (107) .0446 .20745 .9554 .20745 31% (35) 82.5% (93) 15% (2) 1.35% (3) 0 < 2.0% (6) 4% (12) < 1% (4) .0089 .6295 .09449 .45394 .0580 .23002 .0000 .00000 .0000 .0179 .0000 .09321 .0402 .15214 .0089 .06651 98% (109) 84.8% (95) Traffic School Crossings Garden (75%) Mean .0036 112 Surveillance (75%) Traffic Lights AESTHETICS Trees (1 or more per block) Cleanliness (some litter) Mode 3.6% (4) 10.7% (12) 91.1% (102) 112 CHAPTER 4 EFFECT OF NEIGHBORHOOD PERCEPTION ON ACTIVE COMMUTING TO SCHOOL (ACS) AND THE EFFECTIVENESS OF AN EDUCATIONAL INTERVENTION: A PILOT STUDY Abstract This socioecological study investigated the relationship between perception of neighborhood and active commuting to school (ACS). The goal of the educational intervention was to increase safe walking and/or cycling to and from school by fourth grade students. This educational pilot study is based on the premise that ACS can provide much needed physical activity (PA) in children. A pilot study with 16 children and their parents was conducted in the fall of 2017. The 6-week intervention included educational lessons and motivational incentives. Introduction Today, about one in three American kids and teens is overweight or obese (American Heart Association, 2010). The prevalence of obesity in children more than tripled from 1971 to 2011 (Ogden et al., 2006). Childhood obesity and physical inactivity have increased considerably in the past four decades (Ogden, Carroll, Kit, & Flegal, 42 2014). Despite continued attention from health and government agencies across the globe, the physical inactivity pandemic continues to spread, especially in regard to children (Elliot, Stoner, Hamlin, & Stoutenberg, 2016). Since most children travel to school daily, active commuting is considered a promising strategy to increase sustainable physical activity (PA) for children and promote their health (Bjørkelund et al., 2017). Active commuting’s potential to reverse this trend makes it the focus for interventions that promote PA (Fyhri, Hjorthol, Mackett, Fotel & Kytta, 2011). Education and encouragement programs have been associated with an increase in walking and cycling (McDonald, Yang, Abbott, & Bullock, 2013). This study’s purpose is to evaluate the relationship between the perception of neighborhood safety and active commuting to school (ACS). An educational intervention for promoting safe active commuting to school is also included. The intervention is aimed at increasing walking and/or cycling to and from school. Fourth-grade students and their parents from a Mountain West Region were asked to participate in a 6-week program. Classroom lessons were developed from The Safe Routes to School Program’s (SRTS) educational program (https://www.fcgov.com/saferoutes/). This program seeks to increase the number of students safely walking and bicycling to school. Methods Setting and Participants The Institutional Review Boards at the University of Utah and the Salt Lake City School District approved this research. The tenets of human research ethics focus on respect for human dignity and include the following: free and informed consent, respect 43 for privacy and confidentiality, respect for justice and inclusiveness, and respect for vulnerable persons (Canadian Pediatric Society, 2008). Fourth-grade students and their parents were eligible for the study. A Systematic Pedestrian and Cycling Environmental Scan (SPACES) audit showed that the neighborhood within the school boundaries was active-commuter friendly. The ACS educational intervention was developed based on input from parents and school personnel during a School Community Council’s (SCC) meeting where the ACS program’s learning objectives and format were discussed. Student participants were between 9 and 10 years of age. Parent age ranged from 25-54 years of age. Both English and Spanish-speaking subjects participated in the study. All study participants completed the consent and assent forms and all the materials were provided in both languages (see Appendix A). The intervention was implemented September through October of 2017. The program began with 29 student and parent dyads. The attrition rate was high with 13 pairs of participants dropping out, leaving 16 participant dyads. Study Procedures All 29 participants who started the study were included in the ACS program. The central theme of the intervention was safe active commuting. The intervention was taught in weekly 20-minute sessions. Each classroom lesson typically consisted of a Power Point presentation (videos), group participation, and take-home activities (see Appendix C). The first lesson introduced active commuting. Permission forms and survey instruments were collected and an incentive program was explained. Objectives for Lesson 1 included students differentiating between passive and active transportation, 44 students identifying two forms of active transportation, students explaining how active transportation is beneficial, and students listing two pedestrian and bicycle safety guidelines. The goal of the incentive program was to increase awareness and motivation for ACS benefits on a weekly basis. This program offered participation prizes (stickers, pencils, and pens) and entries for a free bicycle drawing at the end of the program. One bicycle per class was offered as part of the incentive program. Besides class participation, students were rewarded for returned, parent-signed (showing they shared it) homework, returned parental permissions, and returned surveys. Lesson 2 covered walking with traffic and the importance of being alert. A LERT, a creature who is constantly aware of what is going on in its environment, was introduced in a class discussion on pedestrian safety. For the group activity, students drew A LERT and wrote two rules that A LERT follows. For example, “A LERT always walks on the sidewalk.” Homework that included students sharing their A LERT drawings and a safe route area map with parents reinforced the lesson. In Lesson 3, the class brainstormed reasons to ride bicycles, including faster travel, no gas, exercise, increased access to destinations, fun, and health promotion. The second part of Lesson 3 covered bicycle maintenance and responsibility. The class learned and practiced the ABC Quick Check mnemonic to remember to check Air, Brakes, Chain & Cranks, and Quick releases before riding. A bicycle parts homeworksheet reinforced the lesson. Lesson 4 covered traffic safety. Students identified traffic sign shapes and meanings. They described proper roadway position and how to be predictable. Students 45 experienced traffic rules’ usefulness in the Traffic Game, where students took turns being make-believe vehicles and pedestrians, using floor lines for practice streets. Homeworksheets covering important traffic signs reinforced the lesson. Lesson 5 covered bicycle helmet safety (commitment to wearing) and fitting. Objectives for this lesson included students verbalizing that helmets can prevent brain injury and recalling the proper fitting steps. Five steps for proper fitting were demonstrated first in a Power Point presentation (videos) and second with verbal recall of the steps as they were demonstrated in person. A bicycle helmet homework sheet reinforced the lesson. Lesson 6 concluded the ACS education intervention program with a review. Each student created their own walking and biking safe route drawing including themselves going to a neighborhood destination. Each student signed the safety pledge: “I, __________, promise to be a safe kid and make street safety a habit. I will walk on sidewalks. I will walk facing traffic so drivers can see me. I will stop at curbs. And I will look left, right, left and listen before and while crossing streets.” At the conclusion of the classroom intervention, the drawing for a free bicycle was held (in each class) and the lucky winner announced! Quantitative Methods Description of Instruments To measure the prevalence and frequency of ACS, students from the fourth-grade class completed the Walking Checklist (see Appendix B) by circling the mode of transportation that they used during specific times. The students completed the checklist 46 twice (once at the beginning of the intervention and again at the end). The checklist format showed good validity (the instrument actually measured what it set out to measure) and good reliability (the instrument can be interpreted consistently across different situations) for this population (Heelan et al., 2005). The students completed a modified version of How Walkable is Your Community (see Appendix B). This survey assessed what students thought about walking and biking in their neighborhood. It included sidewalks, street crossings, and traffic assessment. The parents filled out the Neighborhood Environmental Walkability Scale (NEWS) and a demographic survey (see Appendix B). NEWS is a frequently used questionnaire for assessing perceived attributes of a neighborhood environment for physical activity (de Melo, Menec, Porter, & Ready, 2010). Cerin, Conway, Saelens, Frank, and Sallis (2009) found the instrument reliable and valid. At the end of the intervention, both students and their parents completed a Post-Intervention Evaluation (PIE). The instrument asked participants to rate their program experiences. Results The study results of the Walking Checklist (see Table 4.1) reported no increase in student’s walking and or cycling. The students circled the same responses to how they commuted to school both times the instrument was administered. Table 4.1 showed that in both the pretest and posttest, 13% of students rode the bus, 56% were driven to school, 18% walked, and 12% traveled on light rail (UTA Public Transportation). The demographic survey (see Table 4.2) showed that the average age of the parents was 25-34 years old (62.50%). Almost half (43.75%) of the parents identified 47 their ethnic origin as white and 37.50% identified their origin as Hispanic or Latino. These were the two predominant ethnicity types reported by parents. The educational level most conveyed was the completion of high school or the equivalent (37.50%). Less than half (43.75%) of parents were married or had a domestic partner. Close to half of the parents (43.75%) were employed for wages. The Neighborhood Environment Walkability Scale (NEWS; see Table 4.3) showed that the Mountain West Region neighborhood had many favorable attributes and was conducive to supporting ACS (Saelens, B.E., Sallis, J.F., Chen, D., 2003; see Appendix B). Most parents (93.75%) indicated that their neighborhood had five or more houses, and more than half (56.00-81.25%) reported numerous neighborhood amenities such as convenience stores, clothing stores, elementary schools, transit stops, banks, recreation, and jobs all within a 10-minute walking distance. Most parents (87.50%) reported that stores were within easy walking distance. The majority (87.50%) agreed that it was easy to walk to a transit stop. Most parents reported that the majority of streets in their neighborhood had sidewalks (93.75%) and were well lit (62.50%). A majority (87.00%) agreed that crosswalks and pedestrian signals helped people cross busy streets. Most parents (75.00%) reported that there were trees along the streets and attractive buildings in the neighborhood. Half the parents indicated that the traffic along streets didn’t affect their perception of a safe walking environment. Most (62.50%) reported that there was not a high crime rate in the neighborhood. Finally, a majority of parents (81.25%) agreed that no major barriers made it difficult to get from place to place. The students completed the Walking in Your Neighborhood questionnaire (WIN; see Table 4.4) and the results showed that all (100%) of them rated walking in the 48 neighborhood, first, as good or excellent and, second, as cool or fun. Most (72.70%) students reported no problems with the sidewalks in their neighborhood. A majority (81.80%) indicated it was easy to cross streets, and a majority (84.60%) refuted that drivers drove crazy in their neighborhood. At the end of the ACS educational intervention program both the students and parents were asked to complete a program evaluation questionnaire. The results showed that all (100%) of the students indicated that the ACS program changed their ability to walk or bike safely to school or neighborhood destinations. Most parents (69.00%) responded that the ACS program changed their perception of their child’s ability to walk or bike to school or neighborhood destinations safely. Most parents (69.00% either strongly agreed and agreed) confirmed that the distance to school was a significant barrier to letting their child walk or bike to school. Similarly, most (63% sum of strongly agreed and agreed) agreed that the distance to school was a big problem for allowing them to walk or bike to school. Most (87.50%) students and most (68.75%) parents strongly agreed that the ACS program was beneficial (12.50% of the students and 31.25% of the parents somewhat agreed as well). Most students (87.50%) and most parents (75%) strongly agreed that the ACS program helped increase student well-being and awareness of active commuting risks (12.50% of the students and 25% of the parents somewhat agreed.). Most (56.25 %) parents and most (87.50%) students strongly agreed that the ACS program increased student knowledge of safety rules (43.75% of parents and 12.50% of children somewhat agreed). Most of the students (62.50%) and most of the parents (56.25%) strongly agreed 49 that the ACS program enhanced student motivation to walk/bike to local destinations. An additional 25% of students and 31.25% of parents somewhat agreed with this statement. Half of the students and a third (31.25%) of the parents strongly agreed that the ACS program addressed parental safety concerns and that parents were more willing to allow their children to commute to local destinations after the program. An additional 31.25 % of students and 50% of parents somewhat agreed with this statement as well. All of the students and 37% of the parents strongly agreed that the ACS program increased their confidence in student active commuting skills (43.75% of the parents somewhat agreed). A bivariate correlation analysis (see Table 4.5) was conducted to examine these responses. Results showed a correlation between children liking the ACS program and indicating the program increased their knowledge of the basic safety rules (r =.68, p=.004). Students report that the ACS program helped them become aware of active commuting risks correlated with their reports of the program increasing confidence in their ability to use active commuting as a form of travel (r = .78, p = .00). Also, the children’s report that the ACS program enhanced their motivation correlated with their report that it addressed their parent’s safety concerns about allowing them to commute to destinations close to home (r = .53, p = .03). Parents reported that the ACS program was beneficial despite the fact that the distance to school was a barrier to allowing their child to walk and/or bike (r = .55, p =.02). The parent reports demonstrated a correlation between their indications that the program enhanced ACS motivation and their indications that the program was beneficial (r = .75, p = .001; r = .50, p = .04). The parent report showed a correlation between the program’s increasing their child’s knowledge of basic safety rules and the program 50 increasing their child’s well-being and awareness of active commuting risks (r = .83, p = .00). The parents reported that the ACS program enhanced student motivation and addressed correlated parent safety concerns as well (r = .67, p = .004). Discussion The study findings showed that the intervention did not increase the ACS activity levels in the fourth-grade students. The students’ responses to the Walking Checklist (pretest and posttest) were unchanged. These finding may have been influenced by the distance from home to school. Home proximity to school has been identified as an important determinant of children’s ACS (Timperio et al., 2006). Parents consistently cite distance as the number one barrier to their child’s ACS (Cooper, Anderson, Wedderkopp, Page, & Froberg, 2005). Almost 70% of parents agreed that the distance to school was a significant barrier to letting their child walk or bike to school. A fundamental consideration of parents for allowing their children to actively commute is their perception of what is a close-enough distance (Zhu, 2012). Close to one-half (44%) of parents and students reported that the distance between their home and school was over 2 miles, while another 7.0% of the parents report that they lived between 1.5 and 2 miles away from the school. Research shows that more children walk, and bike to school as the distance decreases (Mc Millan, 2007). The results showed that approximately one-fifth of the students (19%) walked; this result could be a reflection to the parental respond (31%) that they lived within one half mile from the school. Another possible reason for this outcome may be due to the fact that a large 51 number of these students are currently living in a homeless shelter (due to confidentiality regulations, this information was not disclosed until the first week of the intervention). The shelter’s protocol requires that these students receive supervised transportation (bus or car) to school, thus there was no variability between their walking checklist pretestand posttests results. However, regardless of the fact that the distance to school was a barrier to allowing their child to walk and/or bike to school, the parents assessed that the ACS program was beneficial (i.e., improving knowledge and attitudes towards ACS). They indicated that the program addressed their safety concerns and increased their confidence in their child’s understanding of basic traffic safety. Parents agreed that the program increased their child’s knowledge of active commuting risks as well. Finally, they reported that the ACS program enhanced their child’s attitude toward safety, an ACS concern for their child. Pedestrian safe networks and environmental design all affect physical activity (Carver Timperio, Hesketh, & Crawford, 2010; McGrath et al., 2016;). Neighborhoods with attractive pedestrian facilities and local destinations (such as stores and public transport) are more likely to be associated with walking near home (Pikora et al., 2006). Neighborhood Environment Walkability Scale (NEWS) showed that the Mountain West Region neighborhood had many favorable attributes and was conducive to supporting ACS (Saelens et al., 2003). For example, amenities such as convenience stores, clothing stores, elementary schools, transit stops, banks, and recreation were all within a 10minute walking distance. The study finding demonstrated a relationship between parental perception of the neighborhood’s safety and the students ACS behavior. 52 The study showed that the parents thought that the traffic along streets did not affect their perception of a safe walking environment. They indicated that there were crosswalks and pedestrian signals that helped people cross busy streets. Among the most often cited built environmental factors, parents mentioned higher sidewalk availability, well-maintained sidewalks, and safe road crossings. Study findings showed that majority of the streets had tree-lined sidewalks, attractive buildings, and were well lit. Finally, the parents stated that there not any major barriers that made it difficult to get from place to place. In conclusion, environmental factors that have an effect on PA include connectivity, (Braza, Shoemaker, & Seeley, 2004), land use mix, and overall neighborhood design (McCormack & Shiell, 2011). Neighborhoods with more green spaces and attractive streets were positively associated with children’s activity (McGrath et al., 2016). Specific features of the built environment including street and sidewalk upkeep, traffic control devices (Boarnet, Anderson, Day, McMillan, & Alfonzo, 2005), lighting, aesthetics, and destinations seem to encourage physical activity in children (Corder, Sallis, Crespo, & Elder, 2011; Leslie & Cerin, 2008; Pikora et al., 2006;). ACS Intervention Relevance The educational intervention was useful because it provided both students and their parents an opportunity to enhance their active commuting safety knowledge. The skill building aspect of the program increased student’s confidence in their abilities to be safe while commuting in the neighborhood. It also created a positive parental perception between the neighborhood environment and the students ACS behavior. Parents reported 53 that the ACS program was beneficial despite the fact that the distance to school remained a barrier to allowing their child to walk and/or bike to school. This study contributed to the existing body of literature associated with ASC intervention programs. However, more research is needed to evaluate interventions aimed at promoting active commuting in children. Limitations Although the study yielded a number of important insights into children’s ACS participation, the small sample size was a crucial limitation to this study and may have impacted whether statistical significance was found. Another limitation was the study design, as there was no control groups or randomization of participants to different treatment conditions. All participants received the same educational intervention (at the request of the Mountain West Regional School District). The students’ high survey score responses also may have been affected by the Hawthorne Effect. The study finding showed it was not uncommon for students to respond positively to the questions. The Hawthorne Effect is a type of reactivity in which individuals modify an aspect of their behavior in response to their awareness of being observed (McCarney et al., 2007). Most children like to please adults. Future Directions This study contributes to the research on children’s active commuting to school. Future studies should consider involving a larger sample population (either multiple school districts or more classrooms participating in the study). A bigger sample size 54 could produce more statistical power, allowing the use of the data to infer things about the population as a whole. To foster greater program encouragement and enthusiasm, a mix of promotional materials including curriculum, parental, and community promotions (e.g., mapping safe routes to school, walk and bike to school days) can be beneficial. Future programs might also encourage biking to school (for distances over 1 mile and under 2 miles, when feasible). These programs also could include a ride-to-school-day, bike rodeos, bike registration, and bike maintenance events to help trigger behavior change. In regards to the children living in the homeless shelter, I believe that the program was still beneficial to them. This program could not change their mode of transportation to and from school (against the policy of the shelter), but other PA options (within shelter guidelines) could be available through local community programs. 55 References American Heart Association. (2010). Understanding Childhood Obesity. Retreived from: www.heart.org/idc/groups/heartpublic/@wcm/@fc/documents/downloadable/ucm_ 304175.pdf. Bjørkelund, O.A., Christiansen, F. N., Jensen, A. K., Cass, C. J., Andersen, C. R., Maiken, B., & Elling, B. (2017). 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Neighborhood environmental factors correlated with walking near home: Using SPACES. Medicine and Science in Sports and Exercise. 38(4), 708– 714. Saelens, B.E., Sallis, J, F., Chen, D. (2003). Neighborhood-based differences in physical activity: An environmental scale evaluation. American Journal of Public Health, 93, 1552-8. Timperio, A., Ball, K., Salmon, J., Roberts, R., Geo, M., Giles-Corti, B., Simmons, D., Baur, L. A., & Crawford, D. (2006). Personal, family, social, and environmental correlates of active commuting to school. American Journal of Preventive Medicine, (30)1. 57 Zhu, X., & C. Lee. (2009). Correlates of walking to school and implications for public policies: Survey results from parents of elementarysSchool children in Austin, Texas. Journal of Public Health Policy, 30, 2009, pp. S177–S202. 58 Table 4.1 Walking Checklist Results Pre-Test 2 Bus 9 Car 3 Walking 2 TRAX Train Post-Test 2 Bus 9 Car 3 Walking 2 TRAX Train 12.50% 56.25% 18.75% 12.50% 12.50% 56.25% 18.75% 12.50% Table 4.2 Walking in Your Neighborhood (students) Results Neighborhood Walk Rating Awful 0 Problems walking to school Yes 0 Sidewalk Problems None 72.70% Easy to cross streets Yes 81.80% Rating Awful 6.66% Too many cars 63.63% Drivers drive crazy Yes 15.30% Easy to follow rules Stop, look left, right and left again 60.00% Cross at light 90.00% Walked in crosswalks 90.00% Walked facing traffic when no sidewalk 70.00% Was walk cool Yes 100% Many Problems 0 18.75% No 100% Good 45.45% Some Problems 0 Broken sidewalks 9.00% Blocked sidewalks 18.00% Excellent 54.54% No 18.18% Many Problems 20.00% Traffic signals made me wait 27.27% Good 40.00% Need signal/stripped crosswalks 9.09% No 84.60% Some Problems 0 No Some problems Excellent 33.33% 59 Table 4.3 Demographic Survey Results Age 25-34 years old 35-44 years old 45-54 years old Employment Status Employed for wages Out of work-looking Out of work-not looking Homemaker Marital Status Single-never married Married-domestic partner Divorced Ethnicity White Hispanic or Latino African America Asian/Pacific Islander Native American 43.75% 37.50% 6.25% 6.25% 6.25% Education No schooling completed 6.25% 31.25% 43.75% Nursery to 8th grade Some HS-no diploma High school graduate Some College Associates degree 6.25% 6.25% 37.50% 18.75% 6.25% 18.75% Bachelor’s degree 12.50% 62.50% 25.00% 12.50% 43.75% 12.50% 12.50% 25.00% 60 Table 4.4 Neighborhood Environmental Walkability Scale (NEWS) Parents Results Number of Homes/Apts. None 5-10 11-20 All 6.25% 31.25% 18.75% 43.75% Proximity to amenities(walking) Convenience store Supermarket Clothing store Library Elementary school Fast food restaurant Bank Bus or train stop Recreation Center-gym Your job Response Disagree Walking Time 1-10 minutes 1-10 minutes 1-10 minutes 1-10 minutes 1-10 minutes 1-10 minutes 1-10 minutes 1-10 minutes 1-10 minutes Don’t know Response Somewhat Agree Percentage 75.00% 56.00% 56.00% 50.00% 62.50% 58.75% 56.20% 87.50% 62.50% 81.25% Response Strongly Agree NEWS Survey Questions Response Strongly Disagree Stores within easy walking distance Many places within walking distance Easy to walk to transit stop There are many alternative routes from place to place Sidewalks on most streets Sidewalks separate from traffic My neighborhood is well lit Walkers/bikers easily seen Crosswalks help people Tree lined streets Attractive building 0 12.50% 31.25% 56.25% 0 18.75% 31.25% 43.75% 6.25% 6.25% 43.75% 43.75% 6.25% 12.50% 43.75% 37.50% 0 6.25% 25% 68.75% 0 0 56.25% 43.75% 6.25% 31.25% 31.25% 31.25% 0 31.25% 31.25% 37.50% 12.50% 0 43.75% 43.75% 12.50% 12.50% 12.50% 12.50% 37.50% 37.50% 37.50% 37.50% Too much traffic making it difficult to walk High crime rate 18.75% 31.25% 31.25% 18.75% 31.25% 31.25% 25.00% 12.50% Streets are hilly 18.75% 18.75% 37.50% 6.25% Major barriers: difficult to walk 62.50% 18.75% 12.50% 6.25% 61 Table 4.5 ACS Evaluation Correlation Matrix Results Note. Bivariate correlations among variables in Study. *p < .05, ** p < .03, *** p< .001 CHAPTER 5 SUMMARY The purpose of this study was to assess the prevalence of active commuting to school (ACS) and the personal, familial, and environmental factors that affect it. The commuting modes for fourth graders at a Mountain West Region school included walking (18%), bussing (13%), lightrail and other public transportation (12%), and car transportation (56%). A preliminary survey found no students in the study bicycled to school. According to the pre- and postintervention walking checklists (WC), the modes remained unchanged after the 6-week ACS classroom intervention. This lack of change may be attributed to distance, perceived crime rate, inclusivity of the study, and/or study time alloted for planned behavior change. The home-to-school distance was reported as a challenge on the parent postintervention evaluation (PIE). Home proximity to school was identified as an important determinant of children’s active commuting to school behavior (Timperio et al., 2006). Over 70% of parents agreed that the distance to school was a significant barrier to letting their child walk or bike to school. Close to half of parents and students (44%) reported that the distance between their home and school was between 1.5 to 2 miles. An interesting result of the Neighborhood Environment Walking Survey (NEWS) 63 was that most (62.5%) parents indicated that there was not a high crime rate in their neighborhood. This difference in perception shows a demand for further investigation and intervention regarding parent perception of safe ACS. Another possible reason for the lack of commuter behavior change may be due to policy restrictions that affect transportation choices. A large percentage of students in the study were residents in a homeless shelter where protocol requires that the children receive supervised transportation (bus or car) to school. This research was bound by identity-protection (information restriction) and inclusivity (no child was excluded for not being able to fully participate) and the information was not disclosed until the first week of the intervention. To help the homeless children feel included, neighborhood commuting was accentuated. Lack of change in ACS behavior after a 6-week intervention may also have been affected by the study’s short timeframe. Previous research consistently shows that planned behavior change takes time. The behavioral change theory suggests planned behavior change occurs in stages and over extended periods (Transtheoretical Change model; Prohaska & Velicer, 1979). Additionally, the Transtheoretical Change model recognizes that different people are in different stages of readiness for change. It is important not to assume that people are ready for or want to make an immediate or permanent behavior change. By identifying a person's position in the change process, a worker can more appropriately match the intervention to the young person's stage of readiness for change. The perceived environmental predictors of active commuting to school were distance, perceived crime rate, inability to commute, intervention promotion and time for 64 change, natural and built environment, and parent assessment of traffic safety. The Systematic Pedestrian and Cyclist Environmental Scan (SPACES) objectively assessed the natural and built environment within the Mountain West Region school boundaries to determine its ACS friendliness. The SPACES audit results showed street lights, prominently placed visual surveillance, school crossing, numerous traffic lights, and well-maintained, tree-lined sidewalks. This neighborhood showcased activecommuter friendly attributes, including green spaces and local destinations, which gave a positive forecast for active commuting by children. SPACES’ objective neighborhood audit showed the neighborhood was amenable to active commuting even though the walking rate remained steady at 18%. An important benchmark for whether a child will be permitted to participate in ACS is the parental assessment of neighborhood safety, including both personal safety and traffic factors (Giles-Corti et al, 2009). Both the parent and student neighborhood audits (NEWS and WIN) raised awareness of neighborhood walkability. These tools showed the neighborhood was perceived as amenable to active commuting even though the walking rate remained unchanged. Parents noted crosswalks and pedestrian signals that helped people cross busy streets and street traffic that didn’t affect their perception of a safe walking environment. According to the Walking In your Neighborhood (WIN; the neighborhood self-audit for students) results, students also perceived the neighborhood as commuter-friendly. The high prevalence of obesity in children impells public health authorities and parents to search for effective interventions aimed at lowering its health risks. In lieu of this, the study intervention promoted safe ACS by fourth-grade students through 65 education and encouragement to increase physical activity (PA). The primary goal of the intervention program was to boost physical activity in children by increasing ACS participation through fun ACS safety promotion. A quantitative analysis of ACS factors and perceptions was completed on the program instruments: SPACES, demographic survey, NEWS, WIN, WC, sPIE (student postintervention evaluation), and pPIE (parent postintervention evaluation). Despite no change in ACS, performing the neighborhood self-assessments raised awareness of neighborhood walkability. The post intervention evaluations indicated that the safe active commuting lessons were perceived as beneficial by students and parents. Parents indicated that the program addressed their safety concerns and increased their confidence in their child’s understanding of basic traffic safety. Parents agreed that the program increased their child’s knowledge of active commuting risks and enhanced their child’s attitude toward safety as well. Conclusion and Future Directions This research study showed that the Mountain West Region School has an environment amenable to ACS and ACS programming. This study also demonstrated effective standardized tools for ACS research in SPACES, NEWS, Demographics, and Walking Checklist (for pilot studies). Changes recommended for Walking In your Neighborhood instrument include less-leading questions like “do drivers drive crazy?” and scaled opinion questions to match NEWS instead of yes and no. Fill-in the-blank assessments would also help pinpoint Safe Routes to School (SRTS) problem-solving areas (e.g., broken sidewalk) and could be included on an ACS log. Finally, more 66 language translations available for all forms would increase accessibility. This study lacked an Arabic consent form. This small study showed promise for a Mountain West Region school’s active commuting program, even though no actual change in behavior was observed. Its lack of ACS behavior change disqualifies it from contributing to ACS and ACS factor research, but it illustrates a positive intervention using quasi-standardized data-gathering and intervention. Future studies should consider involving a larger sample population either across several grades or over time in a data bank using similar standardized instruments. A more community-based prevalence may increase data and also offer consistency over time in supporting ACS behavior development. A bigger sample could produce more statistical power, and, thus, yeild inferences about the population as a whole. To help include children who may not be able to participate in ACS, a walk-after-lunch-for-recess may help improve ACS-like group participation and accomodate those children do not have access to ACS (e.g., for reasons involving school policy). This pilot study was brief in scope, making it futile to collect BMI or fitness data or track potential growth in ACS participation. Recommendations for future research include the use of a health educator to oversee the ACS log (expanded walking checklist to include frequency, distance, and time - speed), and a BMI log (to help kids own and feel actively responsible and take pride in their stature as well as activity level). Parental perception of distance to school for ACS is a valid concern. Future programs might encourage biking to school (for distances over 1 mile and under 2 miles) and could include a ride-to-school-day, bike rodeos, and bike maintenance events to help trigger behavior change. Including more grades would not only increase the population 67 but acknowledge the principle that fostering a new health behavior takes time. Other classes that could help children and parents adapt for ACS behavior change include time management and weather awareness. Classes that could help with crime perception include stranger-danger, bike-lock and registry, drug-use awareness and prevention, and role-playing reactions to bullying or stray dogs. Also, it may be helpful to confer with the school’s liaison police officer for an objective perspective on neighborhood crime. Although the goal of the study to increase ACS and PA was not met, data showed that there was a positive perception of the ACS intervention and ACS following the study. Planned behavior change takes time. Community investment in a Safe Routes to School-Utah (SR2S) program would offer the continuity and time that this study intervention could not. The Utah Department of Transportation (UDOT) encourages Safe Routes to School, an ACS program that is community-based and community-organized. Under Utah law, all elementary schools are required to create and distribute a SNAP Plan, which shows community-designed-safe routes to school, the first step in a SR2S program. It is recommended that Mountain West communities begin or resume regular ACS education to involve families and promote ACS. SR2S’s free resources could assist in creating a program that increase the safety and health of students. More information about SR2U program can be found at www.udot.utah.gov/snap, and additional resources are available at www.pedbikeinfo.org. 68 References Giles-Corti, B., Timperio, A., Bull, F., & Pikora, T. (2005). Understanding physical activity environmental correlates: Increased specificity for ecological models. Exercise Sport Science Review, 33(4), 175–81. Prochaska, J. O., & Velicer, W.F. (1997). The Transtheoretical Model of health behavior change. American Journal of Health Promotion, 12, 38-48. Timperio, A., Ball, K., Salmon, J., Roberts, R., Geo, M., Giles-Corti, B., Simmons, D., Baur, L. A., & Crawford, D. (2006). Personal, family, social, and environmental correlates of active commuting to school. American Journal of Preventive Medicine, (30)1. The Utah Department of Transportation (UDOT) Safe Routes to School. Retreived from www.udot.utah.gov/snap. APPENDIX A CONSENT FORMS 70 Consent Cover Letter Effectiveness of an Active Commuting to School (ACS) Educational Intervention: A Pilot Study BACKGROUND Your child is being asked to take part in a research study conducted by a Doctoral student from the University of Utah. The purpose of this study is to assess the prevalence of active commuting to school (ACS) in school-aged children and to determine personal, familial and environmental factors related to the ACS that your child is participating in. A key benchmark for whether a child will be permitted to participate in ACS is the parental assessment of how safe the neighborhood is, in terms of both traffic and personal safety. We are doing this study to increase the number of and promote the safety of children walking, biking or using other forms of active travel to school. Before you decide, it is important for you to understand why the research is being done and what it will involve. Please take time to read the following information carefully. Ask us if there is anything that is not clear or if you would like more information. Take time to decide whether or not you will allow your child to take part in this research study. STUDY PROCEDURES All students will participate in the educational intervention which aims to improve students' active commuting skills and awareness as well as to increase their safety. To assess ACS prevalence and determine which factors most shape parental perception and the decision to have children utilize active commuting data will be collected from students and their parents. It will take your child approximately 3 hours to complete this study. Your child will be asked to participate in 6 thirty-minute education lessons. As part of this study, your child will also be asked to complete four questionnaires: two before the program begins and two when it ends. RISKS The risks of this study are minimal. Your child may feel uncomfortable participating in safety activities in the gym. These risks are similar to those experienced when participating in a physical education class. If you feel upset from this experience, you can tell the researcher, and he/she will tell you about resources available to help. BENEFITS We cannot promise any direct benefits for taking part in this study. However, possible benefits included higher daily levels of physical activity and better cardiovascular fitness for children who walk or bicycle to school and increased pedestrian and bike safety knowledge. By participating, your child will be contributing to the evaluation of a program that could help future participants lead more active and healthier lives. PERSON TO CONTACT If you have any questions, complaints, or you feel your child have been harmed by this research, please contact Allison Godbe, lead researcher, Department of Health Promotion and Education, University of Utah, at [e-mail]. You may also contact Dr. Glenn Richardson, Department of Health Promotion and Education, University of 71 Utah, at [phone]. Institutional Review Board: Contact the Institutional Review Board (IRB) if you have questions regarding the rights of your child as a research participant. Also, contact the IRB if you have questions, complaints or concerns which you do not feel you can discuss with the investigator. The University of Utah IRB may be reached by phone at (801) 5813655 or by email at [e-mail] Research Participant Advocate: You may also contact the Research Participant Advocate (RPA) by phone at [phone] or by email at [e-mail]. VOLUNTARY PARTICIPATION Participation in this study is voluntary. Research studies include only people who choose to take part. You can tell us that you don’t want your child to be in this study. Your child can choose not to finish questionnaires or to omit any questions that they prefer not to answer without penalty or loss of benefits. This will not affect their relationship with the investigator. COSTS AND COMPENSATION TO PARTICIPANTS There are no costs and/or compensation to participants. CONFIDENTIALITY Only the researcher and members of her study team will have access to the original questionnaire responses. Your child will never be identified by name in relation to any of his/her answers. To enhance confidentiality, each child will be assigned a participant number to use instead of their name on questionnaires. To further maintain their confidentiality, your child’s demographic information will be separated from other responses before results are shared. After the personal data is removed, the results from this study may be shared with a variety of people, including other researchers from the University of Utah, Salt Lake City School District staff, and the public. The University of Utah Institutional Review Board (IRB), who reviews research involving people will make sure the study protects your rights. What if I decide to Not Participate after I sign the Consent and Authorization Form? You can tell us anytime that you do not want your child to be in this study and do not want us to use your child’s information. You can also tell us in writing. If you change your mind, we will not be able to collect new information about your child, and your child will be withdrawn from the research study. However, we can continue to use information we have already started to use in our research, as needed to maintain the integrity of the research. This authorization does not have an expiration date. CONSENT: I confirm that I have read this parental permission document and have had the opportunity to ask questions. I will be given a signed copy of the parental permission 72 form to keep. I agree to allow my child to participate in this research study and authorize you to use and disclose health information about my child for this study, as you have explained in this document. ________________________ Child’s Name ________________________ Parent/Guardian’s Name ________________________ Parent/Guardian’s Signature ____________ Date ________________________ Relationship to Child for Parent/Guardian ________________________ Name of Person Obtaining Authorization and Consent ________________________ Signature of Person Obtaining Authorization and Consent Date ____________ 73 Consent Cover Letter-Spanish Translation Effectiveness of an Active Commuting to School (ACS) Educational Intervention: A Pilot Study HISTORIAL A su niño se le está pidiendo participar en un estudio de investigación realizado por un estudiante en el programa de su doctorado de la Universidad de Utah. El propósito de este estudio es evaluar la prevalencia del programa de transporte activa a la escuela (ACS) en los niños de edad escolar y determinar factores personales, familiares y ambientales relacionados al programa de ACS en que su niño participará. Un punto de referencia clave para determinar si un niño podrá participar en ACS es la evaluación de los padres sobre la seguridad de su vecindario, en términos de tráfico y seguridad personal. Estamos haciendo este estudio para aumentar el número de niños que caminan, andan en bicicleta o usan otros medios de transportación que mantienen a los estudiantes físicamente activos y promover seguridad mientras van o regresan de la escuela. Antes que usted tome una decisión, es importante que comprenda la razón por la cual se está realizando esta investigación y lo que implica. Por favor tome tiempo para leer la siguiente información cuidadosamente. Pregúntenos si hay algo que no está claro o si desea más información. Tómese el tiempo para tomar su decisión en permitir a su niño participar en este estudio de investigación. PROCEDIMIENTOS DEL ESTUDIO Todos los estudiantes participarán en la intervención educativa que tiene como objetivo mejorar las habilidades de los estudiantes en viajar de forma activa y segura. Para evaluar la prevalencia del programa de ACS y determinar los factores que influyen más la percepción de los padres y decisión de que sus niños utilicen formas activas de viajar a la escuela se coleccionará información de los estudiantes y sus padres. Le llevará su niño aproximadamente 3 horas para completar este estudio. Se le pedirá a su niño que participe en 6 sesiones educativas de treinta minutos. Como parte de este estudio, se le pedirá también a su niño que complete un cuestionario: dos antes que comience el estudio y dos al final del programa. RIESGOS Los riesgos de este estudio son mínimos. Su niño puede ser que se sienta incómodo participando en actividades que enseñan seguridad en el gimnasio. Estos riesgos son similares a aquellos que experimentan cuando participa en la clase de educación física. Si se siente molesto por esta experiencia, puede decirle al investigador, y él/ella le informará sobre los recursos disponibles para ayudarle. BENEFICIOS No podemos prometer beneficios directos al participar en este estudio. Sin embargo, los posibles beneficios incluyen mayores niveles diarios de actividad física y mejor condición cardiovascular para los niños que caminan a la escuela y adquieren un mejor conocimiento de seguridad al caminar y/o andar en bicicletas. Al participar, su niño contribuirá a la evaluación de un programa que podría ayudar a los futuros participantes a 74 llevar una vida más activa y saludable. PERSONAS DE CONTACTO Si usted tiene alguna pregunta, queja o siente que su niño ha sido perjudicado por esta investigación, comuníquese con Allison Godbe, investigadora principal del Departamento de Promoción y Educación de la Salud de la Universidad de Utah, a [e-mail]. Usted también puede ponerse en contacto con el Dr. Glenn Richardson, del Departamento de Promoción de Salud y Educación de la Universidad de Utah, a [phone]. Junta Institucional de Revisión: Usted puede ponerse en contacto con la Junta Institucional de Revisión (IRB) si usted tiene preguntas con respecto a los derechos de su niño como participante de un estudio. También, contacte el IRB si usted tiene preguntas, quejas o preocupaciones que no siente que puede compartir con el investigador. Usted puede comunicarse con el IRB de la Universidad de Utah por teléfono a [phone] o por correo electrónico a [e-mail] Defensa de los Participantes del Estudio: Usted también puede ponerse en contacto con la oficina de Defensa de los Participantes del Estudio “Research Participant Advocate (RPA)” por teléfono a [phone] o por correo electrónico a [e-mail]. PARTICIPACIÓN VOLUNTARIA En este estudio la participación es voluntaria. Los estudios de investigación incluyen sólo las personas que eligen participar voluntariamente. Usted puede decir que desea que su niño no participe. Su niño puede decir que no desea terminar el cuestionario u omitir cualquier pregunta que prefiere no contestar sin ser penalizado o perder beneficios. Esto no afectará su relación con el investigador. COSTOS Y COMPENSACIÓN PARA LOS PARTICIPANTES No hay costos y/o compensación para los participantes. CONFIDENCIALIDAD Sólo el investigador y los miembros del equipo del estudio tendrán acceso a las respuestas originales del cuestionario. Su niño nunca será identificado por su nombre en relación a cualquiera de sus respuestas. Para proteger confidencialidad, se asigna a cada niño un número de participante para usar en lugar de su nombre en los cuestionarios. Para mantener aún más confidencialidad, la información demográfica de su niño estará separada a las otras respuestas y antes de que los resultados sean compartidos. Una vez que la información es tomada, los resultados de este estudio serán compartidos con una variedad de personas, incluyendo otros investigadores de la Universidad de Utah, Miembros del personal del Distrito Escolar de Salt Lake City y el público. La Junta de Revisión Institucional de la Universidad de Utah (IRB, siglas en inglés), quien revisa la participación de las personas se asegurará que el estudio proteja sus derechos. 75 ¿Qué pasa si No Deseo Participar una vez después que firmo el Formulario de Consentimiento y Autorización? Usted puede decirnos en cualquier momento que no desea que su niño participe en el estudio y no desea que usemos la información de su niño, usted también nos puede dejar saber por escrito. Si cambia de idea, no podremos recopilar nueva información sobre su niño, y su niño será retirado del estudio de investigación. Sin embargo, podemos continuar utilizando la información que habíamos empezado a utilizar en nuestro estudio, puesto que debemos mantener la integridad del estudio. Esta autorización no tiene una fecha de vencimiento. CONSENTIMIENTO: Confirmo que he leído el documento de permiso del padre y he tenido la oportunidad de hacer preguntas. Se me va a entregar una copia firmada del formulario de permiso del padre para que guarde. Doy permiso para que mi niño participe en este estudio y autorizo para que se use y comparta la información de mi niño en este estudio, como explicado en este documento. ________________________ Nombre del Niño ________________________ Nombre del Padre/Tutor ________________________ ____________ Firma del Padre/Tutor Fecha ________________________ Relación al Niño con respecto al Padre/Tutor ________________________ Nombre de la Persona Obteniendo Autorización y Consentimiento ________________________ Firma de la Persona Obteniendo Autorización y consentimiento ____________ Fecha COMED AINGE Bennion Parental Permission Document SPANISH 2017-6-20 76 Child Assent Cover Letter Effectiveness of an Active Commuting to School (ACS) Educational Intervention: A Pilot Study Who are we and what are we doing? We are from the University of Utah. We would like to ask if you would be in a research study. A research study is a way to find out new information about something. This is the way we try to find out how children and their parents feel about active commuting to school and neighborhood destinations. Why are we asking you to be in this research study? We are asking you to be in this research study because we want to learn more about your walking, biking and other forms of active commuting behaviors. The primary goal of the program is to promote the safety of you walking, biking or using other forms of active travel to school. We want you to be in this study because walking and biking to school are great ways to increase your daily physical activity. What happens in the research study? If you decide to be in this research study, you and your parent will be asked to fill out some questionnaire related to your active commuting to school behavior and your thoughts on the neighborhood environment. You will be asked to participate in 6 thirtyminute safety education lessons. We will ask you to get involved in the lesson activities. Will any part of the research study hurt you? You may feel uncomfortable participating in safety activities lessons in the gym. These risks are similar to those experienced when you are participating in a physical education class. If you feel embarrassed from this experience, you can tell the researcher, and he/she will tell you about resources available to help. Will the research study help you or anyone else? Possible benefits included higher daily levels of physical activity and better cardiovascular fitness for children who walk or bicycle to school and increased bike safety knowledge. By participating, you will be contributing to the evaluation of a program that could help future children lead more active and healthier lives. Who will see the information about you? Only the researchers or others who are doing their jobs will be able to see the information about you from this research study. We will not tell anyone else that you are in the study. What if you have any questions about the research study? It is okay to ask questions. If you don’t understand something, you can ask us. We want you to ask questions now and anytime you think of them. If you have a question later that you didn’t think of now, you can call Allison Godbe [phone] or ask us the next time we see you. 77 Do you have to be in the research study? You do not have to be in this study if you don’t want to. Being in this study is up to you. No one will be upset if you don’t want to do it. Even if you say yes now, you can change your mind later and tell us you want to stop. You can take your time to decide. You can talk to your parent or guardian before you decide. We will also ask your parent or guardian to give their permission for you to be in this study. But even if your parent or guardian say “yes” you can still decide not to be in the research study. Agreeing to be in the study I was able to ask questions about this study. Signing my name at the bottom means that I agree to be in this study. My parent or guardian and I will be given a copy of this form after I have signed it. Printed Name Sign your name on this line Date Printed Name of Person Obtaining Assent Signature of Person Obtaining Assent Date 78 Child Assent Cover Letter-Spanish Translation Effectiveness of an Active Commuting to School (ACS) Educational Intervention: A Pilot Study ¿Quiénes somos y qué estamos haciendo? Somos de la Universidad de Utah. Nos gustaría preguntarles si desean participar en un estudio de investigación. Un estudio de investigación se lleva a cabo para encontrar nueva información sobre algo. Nosotros estamos tratando de encontrar información sobre cómo los niños y sus padres se sienten de caminar, usar bicicletas (transporte activa) para ir a la escuela y lugares en su vecindario. ¿Por qué le estamos pidiendo que participe en este estudio? Le estamos pidiendo que participe de este estudio porque deseamos aprender más sobre su comportamiento en relación a caminar, andar en bicicletas y otras formas de moverse físicas. El objetivo principal del programa es promover seguridad cuando usted camina, o anda en bicicleta o usa otras formas de movimiento físicas de transportación a la escuela. Deseamos que usted participe en este estudio porque caminar e ir en bicicleta a la escuela es una manera grande de mejorar su actividad física diaria. ¿Qué pasa durante el estudio? Si usted decide participar en este estudio, se le pedirá a usted y su padres que completen un cuestionario relacionado a sus hábitos de transporte a la escuela y sus opiniones sobre el ambiente de su vecindario. Se le va a pedir que participen en 6 lecciones de treinta minutos de educación de seguridad. Le vamos a pedir que participe en las actividades de las lecciones. ¿Cualquier parte del estudio puede causarme daño? Puede ser que usted se sienta incómodo durante las actividades de las lecciones en el gimnasio. Los riesgos son similares a los que usted puede experimentar al participar en una clase de educación física. Si usted se siente avergonzado por esta experiencia, usted le puede dejar saber al investigador, y él/ella le dejará saber de recursos a su disposición. ¿Cómo me va a ayudar a mí y a otros este estudio? Los posibles beneficios incluyen el aumento de niveles diarios de actividades físicas y mejor salud cardiovascular para los niños quienes caminan o andan en bicicletas para ir a la escuela y conocimiento de cómo hacer estas actividades de forma segura. Al participar, usted estará contribuyendo en la evaluación de un programa que puede ayudar a futuros niños vivir una más saludable y activa vida. 79 ¿Quién va a ver mí información? Sólo los investigadores y otras personas que están haciendo su trabajo van a poder ver su información sobre este estudio. No se va a compartir con nadie que no está autorizado en el estudio que usted está participando en este estudio. ¿Qué pasa si tengo preguntas sobre el estudio? Está bien hacer preguntas. Si usted no comprende algo, usted puede hacernos preguntas. Queremos que haga preguntas ahora y en cualquier momento en que piense en una. Si usted tiene una pregunta más tarde que no pensó ahorita, puede llamar a Allison Godbe [phone] o háganos la pregunta la próxima vez que nos reunamos. ¿Tengo que participar en el estudio? Usted no tiene que participar en el estudio si no lo desea. Estar en este estudio es su opción. Nadie va a estar enojado porque usted no desea participar. Aun si primero dice que sí, y luego cambia de idea y nos deja saber que desea dejar de participar. Usted puede tomar su tiempo en pensar si desea participar. Usted puede conversar con su padre/tutor antes de tomar una decisión. Nosotros también vamos a conversar con sus padres y les vamos a pedir su autorización para que usted participe en el estudio. Pero, aunque sus padres digan que “sí”, usted todavía puede decidir no participar en el estudio. Acuerdo de Participar en el Estudio Puedo hacer preguntas sobre este estudio. Al firmar mi nombre a continuación significa que estoy de acuerdo en participar en este estudio. Mi padre o tutor y yo recibiremos una copia de este formulario una vez que esté firmado. Imprima su Nombre Firme su Nombre en esta Línea Fecha Imprima el Nombre de la Persona Recibiendo Permiso Firma de la Persona Recibiendo Permiso Fecha 80 Translation Certification Letter Spanish Short Form Consent Document Effectiveness of an Active Commuting to School (ACS) Educational Intervention: A Pilot Study DATE: June 20, 2017 To Whom It May Concern: The translated documents attached are an accurate Spanish translation of the English versions listed below. These documents are presented for your review. ● ACS Flier ● Active Commuting to School Information Sheet ● Child Assent Form ● Demographic Survey Questions ● NEWS Updated Instrument ● Parental Permission Document I am a Spanish translator. I have a B.A. in Spanish Translation from Brigham Young University, and have served as the translator coordinator for the Salt Lake City School District for the last nine years. I assure the University of Utah Institutional Review Board that these translations are accurate to the best of my knowledge. I also assure the University of Utah Institutional Review Board that I am acting independently from the principal investigator and am not affiliated with this study in any way. If you have any questions, please feel free to contact me through one of the following means: Phone: [phone] Email: [e-mail] Via Salt Lake City School District 440 East 100 South Salt Lake City, Utah 84111 Sincerely, Bob Muench Bob Muench Translator Coordinator APPENDIX B QUESTIONNAIRES 82 Bennion Elementary School’s Active Commuting to School Information Sheet Dear parents/guardians: I am looking forward to introducing and teaching my active commuting to school (ACS) educational research program at Bennion Elementary School! The primary goal of the program is to increase the number of and promote the safety of children walking, biking or using other forms of active travel to school and local destinations. Your child’s and your participation and input in this program is invaluable! If you decide that you both would like to participate, would you please fill out and return all documents that your child has brought home from school today. These include: Parental Permission Document Demographics Survey Questionnaire Neighborhood Environment Walkability Scale (NEWS) These forms are being provided to you in English or Spanish for your convenience. Thank you for filling out these documents. If you could return the filled-out paperwork the following day, that would be helpful. If you have any question please feel free to email me at [e-mail]. Your participation in this program is appreciated! Thank you and have a nice day. Allison Godbe University of Utah Health Promotion and Education Graduate Student 83 Programa de Conmutación Activa de la Escuela Primaria de Bennion Formulario de Información de la Escuela Estimados Padres/Tutores: ¡Estoy muy feliz de presentarles y enseñarles sobre nuestro programa de Conmutación Activa nuevo de investigación educativa (ACS) de la escuela primaria de Bennion! El objetivo principal del programa es mejorar y promover la seguridad de los niños que vienen a la escuela caminando, en bicicleta o utilizando otras formas de transportación a la escuela y a otros lugares locales. ¡La participación de su niño y la de usted es invaluable! Si usted decide que ambos desean participar, por favor complete el formulario y entregue todos los papeles que su niño ha traído hoy a la casa de la escuela. Estos incluyen: Formulario de Consentimiento del Niño Documento de Permiso del Padre Cuestionario de Encuesta Demográfica Escala de Tránsito del Vecindario (NEWS) Estos formularios están a su disposición en inglés y español. Por favor complete los papeles en el idioma que desee. Nos ayudaría muchísimo si usted regresa los papeles completados para el siguiente día. Si usted tiene alguna pregunta por favor no dude en enviarme un correo electrónico a [e-mail]. ¡Su participación en este programa es muy apreciada! Muchas gracias y tengan un buen día. Allison Godbe Universidad de Utah Promoción de Salud y Educación Estudiante Graduado 84 Demographic Survey Questionnaire Age 1. Age: What is your age? ● Under 12 years old ● 12-17 years old ● 18-24 years old ● 25-34 years old ● 35-44 years old ● 45-54 years old ● 55-64 years old ● 65-74 years old ● 75 years or older Ethnicity 2. Ethnicity origin (or Race): Please specify your ethnicity. ● White ● Hispanic or Latino ● Black or African American ● Native American or American Indian ● Asian / Pacific Islander ● Other Education 3. Education: What is the highest degree or level of school you have completed? If currently enrolled, highest degree received. ● No schooling completed ● Nursery school to 8th grade ● Some high school, no diploma ● High school graduate, diploma or the equivalent (for example: GED) ● Some college credit, no degree ● Trade/technical/vocational training ● Associate degree ● Bachelor’s degree ● Master’s degree ● Professional degree ● Doctorate degree Household Composition 4. Marital Status: What is your marital status? ● Single, never married ● Married or domestic partnership 85 ● ● ● Widowed Divorced Separated Professional or Employment Status 5. Employment Status: Are you currently…? ● Employed for wages ● Self-employed ● Out of work and looking for work ● Out of work but not currently looking for work ● A homemaker ● A student ● Military ● Retired ● Unable to work 6. Number of Children in household? ● 1 ● 2 ● 3 ● 4 ● 5 or more 86 Cuestionario de Encuenta Demográfica Edad 7. Edad: ¿Cuál es su edad? ● Menor de 12 años ● 12-17 años de edad ● 18-24 años de edad ● 25-34 años de edad ● 35-44 años de edad ● 45-54 años de edad ● 55-64 años de edad ● 65-74 años de edad ● 75 años de edad o mayor Etnicidad 8. Origen étnico (o Raza): Por favor especifique su origen étnico. ● Blanco ● Hispano o Latino ● Negro o Afroamericano ● Nativo de América o Indio Americano ● Asia / Islas del Pacífico ● Otros Educación 9. Educación: ¿Cuál es el nivel de educación mayor que usted ha terminado? Si en el momento usted está registrado en la escuela, mencione el mayor de educación que ha recibido. ● No terminé la escuela ● Terminé hasta el 8vo grado ● Terminé un poco de la secundaria, no diploma ● Me recibí de la secundaria, recibí un diploma o un equivalente ( por ejemplo: GED) ● Tengo un poco de créditos universitarios, no diploma ● Oficio/técnico/entrenamiento vocacional ● Diploma de Asociado ● Diploma de Bachiller ● Diploma de Maestría ● Diploma Profesional ● Doctorado Composición del Hogar 10. Estado Civil: ¿Cuál es su estado civil? 87 ● ● ● ● ● Soltero, nunca casado Casado o Asociación Doméstica Viuda Divorciada Separada Profesión o Estado de Empleo 11. Estado de Empleo: ¿Está empleado en el momento…? ● Empleado con Sueldo ● Auto-empleado ● Sin trabajo y buscando trabajo ● Sin trabajo pero no buscando trabajo en el momento ● Ama de casa ● Estudiante ● Militar ● Jubilado ● Sin poder trabajar 12. ¿Cuántos niños en su hogar? ● 1 ● 2 ● 3 ● 4 ● 5 ó más COMED AINGE Bennion Demographic Survey Question SPANISH 2017-6-20 88 Neighborhood Environment Walkability Scale (NEWS) Please circle your answer 1. In your neighborhood, how many homes and apartments are there? None 5-10 11-20 All 2. In your neighborhood, how much time does it take to walk to: Convenience/small grocery store don’t know 1- 5 min 6-10 min 11-20 min 21-30 min Supermarket/ Pharmacy/ Hardware store 1- 5 min 6-10 min 11-20 min 2130 min don’t know Laundry/dry cleaners 1- 5 min 6-10 min 11-20 min 21-30 min don’t know Clothing store Library 1-5 min 1- 5 min 1- 5 min Elementary school Your job 1- 5 min 6-10 min Recreation center/Gym/Park don’t know 1- 5 min 6-10 min 3. Stores are within easy walking distance. Strongly disagree Somewhat disagree don’t know 21-30 min 21-30 min 21-30 min 11-20 min don’t know 21-30 min 11-20 min 11-20 min don’t know 21-30 min 11-20 min 11-20 min 6-10 min 21-30 min 11-20 min 6-10 min 6-10 min 1- 5 min 11-20 min 6-10 min 1- 5 min 1- 5 min Bus or train stop 6-10 min 1- 5 min Fast food/restaurants know Bank/credit union 6-10 min don’t know don’t know 21-30 min 11-20 min don’t don’t know 21-30 min Somewhat agree Strongly agree There are many places to go within walking distance at my home. Strongly disagree Somewhat disagree Somewhat agree Strongly agree It is easy to walk to a transit stop (bus, train) from my home. Strongly disagree Somewhat disagree Somewhat agree Strongly agree 4. The distance between intersections in my neighborhood is usually short. Strongly disagree Somewhat disagree Somewhat agree Strongly agree 89 There are many alternative routes for getting from place to place in my neighborhood. Strongly disagree Somewhat disagree Somewhat agree Strongly agree 5. There are sidewalks on most of the streets in my neighborhood. Strongly disagree Somewhat disagree Somewhat agree Strongly agree Sidewalks are separated from the road/traffic in my neighborhood by parked cars. Strongly disagree Somewhat disagree Somewhat agree Strongly agree There is a grass/dirt strip that separates the streets from the sidewalks in my neighborhood. Strongly disagree Somewhat disagree Somewhat agree Strongly agree My neighborhood is well lit at night. Strongly disagree Somewhat disagree Somewhat agree Strongly agree Walkers and bikers on the streets in my neighborhood can be easily seen by people in their homes. Strongly disagree Somewhat disagree Somewhat agree Strongly agree There are crosswalks and pedestrian signals to help people cross busy streets in my neighborhood. Strongly disagree Somewhat disagree Somewhat agree Strongly agree 6. There are trees along the streets in my neighborhood. Strongly disagree Somewhat disagree Somewhat agree Strongly agree There are many interesting things to look at while walking in my neighborhood. Strongly disagree Somewhat disagree Somewhat agree Strongly agree There are many attractive natural sights in my neighborhood. Strongly disagree Somewhat disagree Somewhat agree There are attractive buildings/homes in my neighborhood. Strongly disagree Somewhat disagree Somewhat agree Strongly agree Strongly agree 7. There is so much traffic along nearby streets that it makes it difficult or unpleasant to walk in my neighborhood. Strongly disagree Somewhat disagree Somewhat agree Strongly agree The speed of traffic on most nearby streets is usually slow. Strongly disagree Somewhat disagree Somewhat agree Strongly agree Most drivers exceed the posted limits while driving in my neighborhood. Strongly disagree Somewhat disagree Somewhat agree Strongly agree 90 8. There is a high crime rate in my neighborhood. Strongly disagree Somewhat disagree Somewhat agree Strongly agree The crime rate in my neighborhood makes it unsafe to go on walks during the day. Strongly disagree Somewhat disagree Somewhat agree Strongly agree The crime rate in my neighborhood makes it unsafe to go on walks at night. Strongly disagree Somewhat disagree Somewhat agree Strongly agree 9. Parking is difficult in local shopping areas. Strongly disagree Somewhat disagree Somewhat agree Strongly agree 10. The streets in my neighborhood do not have many cul-de-sacs. Strongly disagree Somewhat disagree Somewhat agree Strongly agree 11. The streets in my neighborhood are hilly, making my neighborhood difficult to walk in. Strongly disagree Somewhat disagree Somewhat agree Strongly agree 12. There are major barriers to walking in my neighborhood that make it hard to get from place to place (for example, freeways, railway lines, rivers, canyons, hillsides). Strongly disagree Somewhat disagree Somewhat agree Strongly agree 91 Escala de Medidas de Transito en el Ambiente del Vecindario (Nuevo) 1. ¿En su vecindario, cuántas casas y departamentos existen? Ninguno 5-10 11-20 Todo 2. ¿En su vecindario, cuánto lleva caminando para llegar a…?: Almacén/Tienda pequeña no sé 1- 5 min 6-10 min Supermercado/ Farmacia/ Herradero min no sé Lavaderos/secadoras Tienda de ropas Biblioteca 1- 5 min 1- 5 min 1- 5 min Escuela Primaria 6-10 min 6-10 min 6-10 min 1- 5 min Comida rápida/restaurantes no sé 1- 5 min Autobús o parada de tren no sé 6-10 min 11-20 min 1- 5 min 1- 5 min 6-10 min 1- 5 min Centro de Recreación/Gimnasio/Parque 30 min no sé 21-30 min 11-20 min no sé no sé no sé 21-30 min 11-20 min 6-10 min 21-30 21-30 min 21-30 min 6-10 min 21-30 min 11-20 min 11-20 min 11-20 min 6-10 min Bancos/Cooperativas de créditos no sé Su trabajo 1- 5 min 11-20 min no sé 21-30 min 11-20 min 21-30 min 11-20 min 21-30 min no sé 6-10 min 11-20 min 21-30 min 6-10 min 11-20 min 1- 5 min 3. Las tiendas quedan a poca distancia a pie. Muy en desacuerdo Algo en desacuerdo acuerdo Algo de acuerdo Muy de 4. Hay muchos lugares para ir caminando de mi casa. Muy en desacuerdo Algo en desacuerdo Algo de acuerdo acuerdo Muy de 5. Es fácil caminar a una parada de autobús/tren de mi casa. Muy en desacuerdo Algo en desacuerdo Algo de acuerdo acuerdo Muy de 21- 92 6. La distancia entre las intersecciones en mi vecindario usualmente son cortas. Muy en desacuerdo Algo en desacuerdo Algo de acuerdo Muy de acuerdo 7. Hay muchas rutas alternativas para ir de un lugar a otro en mi vecindario. Muy en desacuerdo Algo en desacuerdo Algo de acuerdo Muy de acuerdo 8. Hay aceras/veredas en la mayoría de las calles en mi vecindario. Muy en desacuerdo Algo en desacuerdo Algo de acuerdo Muy de acuerdo 9. Las aceras/veredas están separadas de las calles/tránsito en mi barrio de los autos estacionados. Muy en desacuerdo Algo en desacuerdo Algo de acuerdo Muy de acuerdo 10. Hay un área de pasto/tierra entre la calle y la vereda en mi vecindario. Muy en desacuerdo Algo en desacuerdo Algo de acuerdo Muy de acuerdo 11. Mi vecindario está bien iluminado por las noches. Muy en desacuerdo Algo en desacuerdo Algo de acuerdo acuerdo Muy de 12. La gente caminando y ciclistas en las calles pueden ser visto fácilmente por las personas desde sus casas en el vecindario. Muy en desacuerdo Algo en desacuerdo Algo de acuerdo Muy de acuerdo 13. Hay peatonales y señas de cruces para ayudar a las personas cruzar calles ligeras en mi vecindario. Muy en desacuerdo Algo en desacuerdo Algo de acuerdo Muy de acuerdo 14. Hay árboles a lo largo de las calles en mi vecindario. Muy en desacuerdo Algo en desacuerdo Algo de acuerdo acuerdo Muy de 15. Hay muchas cosas interesantes para ver mientras se camina en mi vecindario. Muy en desacuerdo Algo en desacuerdo Algo de acuerdo Muy de acuerdo 16. Hay lugares naturalmente atractivos en mi vecindario. Muy en desacuerdo Algo en desacuerdo Algo de acuerdo acuerdo Muy de 93 17. Hay edificios/casas atractivas en mi vecindario. Muy en desacuerdo Algo en desacuerdo Algo de acuerdo acuerdo Muy de 18. Hay tanto tránsito a lo largo de las calles cercanas que es dificultoso o no placentero caminar en mi vecindario. Muy en desacuerdo Algo en desacuerdo Algo de acuerdo Muy de acuerdo 19. La velocidad del tránsito en las calles cercanas es usualmente lento. Muy en desacuerdo Algo en desacuerdo Algo de acuerdo Muy de acuerdo 20. La mayoría de los autos exceden los límites de velocidad cuando manejan en mi vecindario. Muy en desacuerdo Algo en desacuerdo Algo de acuerdo Muy de acuerdo 21. Hay un nivel alto de crimen en mi vecindario. Muy en desacuerdo Algo en desacuerdo Algo de acuerdo acuerdo Muy de 22. El nivel de crimen en mi vecindario hace que sea peligroso caminar durante el día. Muy en desacuerdo Algo en desacuerdo Algo de acuerdo Muy de acuerdo 23. El nivel de crimen en mi vecindario hace que sea peligroso caminar durante la noche. Muy en desacuerdo Algo en desacuerdo Algo de acuerdo Muy de acuerdo 24. Estacionar es bien difícil en las tiendas locales. Muy en desacuerdo Algo en desacuerdo Algo de acuerdo Muy de acuerdo 25. Las calles en mi vecindario no tienen muchas calles sin salidas. Muy en desacuerdo Algo en desacuerdo Algo de acuerdo Muy de acuerdo 26. Las calles en mi vecindario son muy montañosas que hace difícil caminarlas. Muy en desacuerdo Algo en desacuerdo Algo de acuerdo Muy de acuerdo 27. Hay muchas barreras para caminar en mi barrio que hace difícil ir de un lugar a otro (por ejemplo, carreteras, vías de tren, ríos, cañones, barrancas). Muy en desacuerdo Algo en desacuerdo Algo de acuerdo Muy de acuerdo 94 Walking Checklist How Do You Get to School? Circle one Name___________________ Teacher________________ WALK RIDE THE BUS BIKE CAR 95 Walking in Your Neighborhood Location of walk____________________________ Rating Scale 1 2 3 4 Awful Many Good Excellent 1. Do you have problems walking to school? ___Yes ___No ___Some problems Rating: (circle one) 1 2 3 4 2. Sidewalk Problems ___ Sidewalks are broken ___ Sidewalks are blocked ___ No sidewalks or paths 3. Was it easy to cross streets? ___Yes ___No ___ Some problems Rating: (circle one) 1 2 3 4 ___Too many cars ___Traffic signal made us wait or not given enough time to cross ___Needed striped crosswalk or traffic signal 4.Do drivers drive unsafely? ___Yes ___No Some problems Rating: (circle one) 1 2 3 4 ___Drive too fast ___Turn into people crossing the street ___Backed out of driveways without looking 4. Was it easy to follow safety rules? ___Yes ___No Rating: (circle one) 1 2 3 4 ___Yes ___No Stop and look left, right and left again? ___Yes ___No Crossed at light? ___Yes ___No Walked in crosswalks? ___Yes ___No Walked facing traffic when there were no sidewalks? 5. Was your walk cool/fun? ___Yes ___No ___Some problems Rating: (circle one) 1 2 3 4 96 ___Need more grass, flowers, or trees ___Scary dogs ___Scary people ___Dirty, lots of trash ___Not well light GOOD JOB THANK YOU 97 SPACES Observation Manual Q1a. Type of buildings/features – includes both built and natural features. Indicate ALL buildings/features present on the street/road. Ignore vacant blocks. Transport infrastructure – includes car parks, freeways and highways, off and on ramps, railway tracks, and bus and railway stations that are a major feature on the road/street. Housing includes all residential dwelling types – such as single house, a duplex, housing units, and flats. If there is mixed zoning with residential dwellings above offices and shops, then all applicable boxes would be checked – i.e., housing, office, and retail. Office – includes any type of office, such as accountant, bank, real estate agent. Also includes offices that are located in houses. Convenience Stores – includes any shop that sells household products, such as corner store, newsagent, chemist, delicatessen, supermarket. Other Retail – includes other businesses not included in convenience store category. Includes petrol station, a tire center, car repair, car yard. Industrial – includes any industries, such as engineering, manufacturing. Educational – includes schools, universities, and colleges. Services – includes any doctor or dentist surgeries, child health clinics, child care centers. Natural features – includes such things as parks, the river, the beach, bushland, golf course, outdoor sporting centers. Q1b. Predominant buildings/features – indicate which of the above buildings/features are the most predominant for each side of the street. Q1c. Are the predominant buildings or features the same on both sides of the segment? YES/NO SECTION A. WALKING AND CYCLING PATHS. Q2. Path type – if there is no path on either side, tick first box and go to SECTION B. Footpath – a man-made surface (such as brick, stone, concrete slabs, continuous concrete) designed for pedestrians to use. (See Fig. 1) Also includes any naturally created or occurring walking surfaces. (See Fig. 2) Shared path with markings – path used by a range of users, including pedestrians, cyclists, small-wheeled vehicle users, with center line, logos and another pavement markings included for safety or convenience. (See Fig 3.) Shared path with no markings – path used by a range of users, including pedestrians, cyclists, small wheeled vehicle users with no markings. (See Fig. 4) If the path is under repair of under construction record as no path present. Fig 1. Footpath Fig. 2. Footpath Fig. 3 Shared path with markings Fig. 4 Shared path with no markings Q3. Path location – how close is the path to the edge of the street/road? Estimate the distance between the path and the edge of the road. Next to the road/street (see Fig. 6) Within 1m of curb (see Fig. 7) 98 Between 1 and 2m of curb (see Fig. 8) Between 2 and 3m of curb More than 3m from curb (see Fig. 9) If the path varies in location, indicate the distance for the majority of the segment Fig. 6 Next to road Fig. 7 Within 1m of curb Fig. 8 Between 1 & 2m of curb Fig. 9 More than 3m from curb Q4. Path material – what material is the path made of? Continuous concrete (see Fig. 10) Concrete slabs (see Fig. 11) Paving bricks (see Fig. 12) Gravel Bitumen (see Fig. 13) Grass or sand (see Fig. 14) Path is under repair If the path varies in material, indicate the material that the majority of the path is made of. Fig. 10 Continuous concrete Fig. 11 Concrete slabs Fig. 12 Paving bricks Fig 13 Bitumen Fig. 14 Grass or sand Q5. Slope – how steep is the path? Assess the slope based on the gradient of the majority of the segment. For example, if the beginning of a segment has a moderate slope but the majority is flat, score it as ‘flat’. If the segment is evenly divided between two gradients, then score it based on the biggest gradient. For example, if the segment has both a slight and a moderate slope, then score it as ‘moderate’. A flat or gentle slope is when the path has no slope or a slight or gradual incline. (See Fig. 14) A moderate slope is one with a medium incline. (See Fig. 15) A steep slope is one with a sharp or rapid incline. (See Fig. 16 & 17) Fig. 14. Flat or gentle slope Fig. 15 Moderate slope Fig. 16 Steep slope Fig. 17 Steep slope 10 Q6. Path condition and smoothness – is the path well maintained? Are the crossovers smooth? A poor path is one with a lot of bumps, cracks, holes and weeds growing in the surface or between the cracks. The crossover from the path to the street is rough, with large gaps or holes. (See Fig. 18) A moderate path is one with some bumps, cracks, holes and weeds growing in the surface or between the cracks but not as many as a poor path. The crossover from the path to the street is mostly smooth although there are some crossovers with holes or gaps. (See Fig. 19) A good path is one with very few bumps, cracks, holes and weeds growing in the surface or between the cracks. The crossover from the path to the street is smooth with no holes or gaps. (See Fig. 20) If path is under repair, mark as under repair 99 Fig. 18 Poor path Fig. 19 Moderate path Fig. 20 Good path Q7. Permanent path obstructions – are there any poles, signs, table and chairs that permanently obstruct the path? These are considered permanent only if they can not be moved, such as when they are fixed to the ground. Poles Signs Tables & chairs None SECTION B. STREET ASSESSMENT. Complete this section for each segment. Q8. Lane type (for on-road cycling) – On-road cycle lane that has been marked – provision of lane markings, signs and/or bicycle logos to identify a space allocated for cycling on the street or road. On-road cycle lane with no markings – provision of a wider lane allowing a cyclist to ride on the street or road but has no markings. Q9. Slope – how steep is the street/road? Only complete if there is no path. Assess the slope based on the gradient of the majority of the segment. For example, if the beginning of a segment has a moderate slope but the majority is flat, score it as ‘flat’. If the segment is evenly divided between two gradients, then score it based on the biggest gradient. For example, if the segment has both a slight and a moderate slope, then score it as ‘moderate’. A flat or gentle slope is when the street/road has no slope or a slight or gradual incline. (See Fig. 21) A moderate slope is one with a medium incline. (See Fig. 22) A steep slope is one with a sharp or rapid incline. (See Fig. 23 & 24) Fig. 21. Flat or gentle slope Fig. 22 Moderate slope Fig. 23 Steep slope Fig. 24 Steep slope Q10. Street/road condition – how well maintained is the street/road? A poor street/road is one with a lot of bumps, cracks, and holes. A moderate street/road is one with some bumps, cracks, and holes but not as many as a poor street/road. A good street/road is one with very few bumps, cracks, and holes. If the street is having repairs, record as under repair. Q11. Number of lanes on the street/road – the total number of traffic lanes. For example, Clifton Street has 2 lanes, while Stirling Highway has 4. Q12. Vehicle parking restriction signs – are there any vehicle parking restrictions indicated? No parking allowed – signs indicating parking restrictions. Parking allowed – no parking restrictions are shown. Q13. Curb type – what type of curb is in the section? If the curb is different on each side of the road, then record the type on the side that you are walking. Assess the curb type based on the majority of the segment. For example, if the beginning of a segment has a mountable curb but the majority has a non-mountable 100 curb, score it as ‘non-mountable’. Mountable – the curb is flush or mountable by a bicycle. (See Fig. 25) Non-mountable – the curb is high and is not easily mountable by a bicycle. (See Fig. 26) No curb – there is no curb aligning the street/segment. Fig. 25. Mountable curb Fig. 26. Non-mountable curb Q14. Traffic control devices – devices that slow or restrict traffic flow through an area. Tick ALL in the segment. Record any traffic control devices at the beginning of the segment or along the segment. devices at the end of the segment are NOT RECORDED for that segment, but are recorded for the next segment. Roundabouts – traffic circles designed to slow traffic speed through an intersection. (See Fig. 27) Ramps or speed humps – short raised sections along the road to slow traffic. (See Fig. 28) Chicanes, chokers, curb extensions or lane narrowing – these narrow the lane width, and create a perception that vehicles need to travel at a slower speed. (See Fig. 29) Traffic signals – these ensure that vehicles will stop for a certain period, to allow pedestrians to cross the street and cyclists to wheel their bikes across. Fig. 27 Roundabout Fig. 28 Ramp or speed hump Fig. 29 Chicane Q15. Other routes available – these provide alternative ways of walking or cycling in the neighborhood. Tick ALL that are applicable to the segment Lane – a narrow local street located along the rear and/or side property boundary. Lanes are often found in dense residential areas when rear parking or where alternative vehicle access is necessary. (See Fig. 30). Can also be a path between buildings. (See Fig. 31) Access lane through cul-de-sac or no through road – a path or lane that allows easy access through a cul-de-sac or no through road. (See Fig. 32 & 33) Path through park – a designated path through a park or open space. Fig. 30 Lane Fig. 31 Lane Fig. 32 Access lane through cul-de-sac Fig. 33 Access lane for no through road Q16. Type of crossings – tick ALL that are in the segment Zebra or children’s – specifically marked crossings. Traffic signals with pedestrian push buttons. Bridge/overpass – facilities that are physically separated to allow crossing above the traffic. Underpass – facilities that are physically separated to allow crossing below the traffic. Q17. Crossing aids – tick ALL that are in the segment Median refuge and traffic island – these provide a safe place for pedestrians or cyclists where it is difficult to cross the full width of a road in one stage. (See Fig. 34 & 35) Curb extensions – these minimize the width of the road to be crossed and are commonly placed at intersections and mid-block. Fig. 34 Median refuge Fig. 35 Traffic island & median refuge Q18. Presence of streetlights – are streetlights present in the segment? 101 If NO, go to Q 20. Q19. Does the lighting cover the path area – are the lights positioned to shine over the path area? (See Fig. 36 & 37) Are there any obstructions from trees? Fig. 36 Lights over path Fig. 37 Lights over path Q20. Are destinations present in the segment – are there any destinations that people may walk or cycle to such as shops, a school, park, etc. If NO, go to Q 23. Q21. Number of car parking facilities at destinations – estimate the number of car parking spaces that are at each of these destinations. 0 1-20 21-50 51-70 71-100 100+ Q22. Bike parking facilities – Bike locker or enclosure – allows bikes and personal equipment to be locked in individual lockers or communal enclosures. Bike parking or U rails – standard bike parking rail or U rail parking. (See Fig. 38) Rack or stand – ‘toast rack’ bike parking racks. (See Fig. 39) Fig. 38 Bike parking rail Fig. 39 ‘Toast rack’ parking Q23. Driveway crossovers – estimate the number of driveways per building in the segment. Most buildings have one driveway Approximately ½ buildings have one driveway Approximately ¼ buildings have one driveway No driveways Q24. Surveillance (or “eyes on the street”) – the enhancement of personal safety or the perception of personal safety through the opportunity for a person to be seen by other people. Can a pedestrian be observed from a window, verandah, porch, etc.? Fig. 40 Good surveillance Fig. 41 Good surveillance Q25. Garden maintenance – well-maintained gardens look trim and clean; any lawn appears to be regularly mowed. The gardens look kept up. How well maintained are the gardens in the segment? Estimate the proportion of gardens that are well maintained. If there is only a glimpse of a garden, then this garden would not be rated. More than 75% well-maintained Between 50 – 74% well-maintained Less than 50% well-maintained Not applicable Q26. Verge maintenance – well-maintained verges look trim and clean; grass appears to be regularly mown. The verge looks kept up. How well maintained are the verges in the segment? Estimate the proportion of verges that are well maintained. More than 75% well-maintained 102 Between 50 – 74% well-maintained Less than 50% well-maintained Not applicable Q27. Number of verge trees – estimate the number of trees that are planted along the verge. 1 or more trees per house block. Approximately 1 tree for every 2 house blocks. Approximately 1 tree for every 3 or more house blocks. No trees at all. Q28. Average height of the trees – estimate the height of the trees along the verge. Small – the majority of the trees are head high or less. (See Fig. 52 & 53) Medium – the majority of the trees are between head and ceiling height. (See Fig. 54) Large – the majority of the trees are higher than ceiling height. Q29. Cleanliness – is there any litter, rubbish, graffiti, broken glass, discarded items in the segment? Yes, lots – there is a large amount of litter, rubbish, etc. in the segment. Yes, some – there is a very small amount of litter, rubbish, etc. in the segment but not a great amount. None or almost none – there is no or very little litter, rubbish, graffiti, etc. in the segment. Q30. Types of views – Urban – houses and household gardens. (See Fig. 56 & 58) Commercial – includes shops, offices, light industrial, schools, etc. (See Fig. 57 & 59) Water – river, ocean, lake, etc. (See Fig. 58 & 59) Tended nature – parks and community gardens that are “looked after” and are well maintained. (See Fig. 50) Nature – parks, community gardens where the level of care differs. An example of nature is Kings Park where there are natural bush areas as well as lawns and gardens that are well maintained. Q31. How alike are the building designs – All are similar Range of different designs Not applicable Q32. How attractive would you rate this segment for walking? Very attractive – segment was aesthetic pleasing to walk in; there were no aspects that we’re not pleasing. Attractive – segment was mostly aesthetic pleasing to walk in; there were a few aspects that were not pleasing. Not attractive at all – segment was aesthetically unpleasant to walk in; there were many aspects that were unpleasant, such as a large amount of rubbish, the majority of gardens and verges not well maintained, all buildings of the same or very similar design. Q33. How physically difficult would you rate this segment for walking? Easy – segment was physically comfortable and easy to walk in; there were no physical aspects that were a problem for walking. Moderately difficult – there were some difficulties walking in the segment; there were a 103 few physical aspects that were a problem for walking Very difficult – segment was physically uncomfortable and difficult to walk through; there were many aspects that were a problem, such as no path or a path that was uneven or cracked, steep slope, no verge trees for shade, a busy street with no way to cross. Q34. How attractive would you rate this segment for cycling? Very attractive – segment was aesthetic pleasing to cycle in; there were no aspects that were not pleasing. Attractive – segment was mostly aesthetic pleasing to cycle in; there were a few aspects that were not pleasing. Not attractive at all – segment would be aesthetically unpleasant to cycle in; there were many aspects that would be unpleasant such as a large amount of rubbish, the majority of gardens and verges not well maintained, all buildings of the same or very similar design. Q35. How physically difficult would you rate this segment for cycling? Easy – segment would be physically comfortable and easy to cycle in; there were no physical aspects that were a problem for cycling. Moderately difficult – there would be some difficulties cycling in the segment; there were a few physical aspects that would be a problem for cycling. Very difficult – segment would be physically uncomfortable and difficult to cycle in; there were many aspects that were a problem, such as a steep slope, a busy street with no cycle lane, the road is in poor condition, there are many traffic control devices in the segment. SECTION C. OVERALL ASSESSMENT. Complete for each section when the data for all the individual segments have been collected. Q36. Continuity of the path Is the path continuous? Yes – the path forms a useful, coherent and direct route to a destination. No – the path is disjointed. It does not form any useful way to any destinations. Q37. Neighborhood legibility – how easy was it to find your way around the neighborhood? How easy was it to figure out where you were at any given moment or? to find your way back to any given point? Very easy – there were no problems with getting around the neighborhood. At no time were you confused about which direction to take? Fairly easy – there were times when you were somewhat confused but this was for less than half the time. Not easy at all – if you had turned around twice you would have been lost. There were many confusing aspects in the neighborhood. 104 Student ACS Education Safety Program Evaluation Has the Active Commuting to School (ACS) Safety Education Program changed your ability to walk or bike safely to school or neighborhood destinations? Yes No The ACS safety program was good and I liked it. ___ Strongly agree ___ Somewhat agree ____ Somewhat disagree ___ Strongly disagree The ACS program helped me to be aware of active commuting risks. ___ Strongly agree ___ Somewhat agree ____ Somewhat disagree ___ Strongly disagree The ACS program increased my knowledge of basic safety rules, and helped me identify traffic signs and understanding of how to behave safely and responsibly when walking or biking. ___ Strongly agree ___ Somewhat agree ____ Somewhat disagree ___ Strongly disagree The distance to school was big problem for allowing me to walk or bike to school. ___ Strongly agree ___ Somewhat agree ____ Somewhat disagree ___ Strongly disagree The distance to school is ____Less than ½ mile ____Between ½ and a mile ____A mile ____Between 1½ and 2 miles ____Over 2 miles The ACS Education Program enhanced my motivation/desire to walk/bike to school or local destinations. ___ Strongly agree ___ Somewhat agree ____ Somewhat disagree ___ Strongly disagree I feel that the ACS Education program addressed my parent’s safety concerns and they are more willing let me commute to destinations close to my home (within 1 mile). ___ Strongly agree ___ Somewhat agree ____ Somewhat disagree ___ Strongly disagree The ACS program increasing my confidence and it was fun. ___ Strongly agree ___ Somewhat agree ____ Somewhat disagree ___ Strongly disagree Thank You It was great having you in class! 105 Parental ACS Bicycle and Pedestrian Education Safety Program Evaluation Has the Active Commuting to School (ACS) Safety Education Program changed your perceptions of your child’s ability to walk or bike safely to school or neighborhood destinations? Yes No The ACS safety program was beneficial and enhanced my child’s safety knowledge of walking and biking. (Pedestrian/Bicyclist training program ensured that students understood, and practiced basic rules). ___ Strongly agree ___ Somewhat agree ____ Somewhat disagree ___ Strongly disagree Helped my child learn how Pedestrian/Bike safety can increase their well-being and reduce active commuting risks. ___ Strongly agree ___ Somewhat agree ____ Somewhat disagree ___ Strongly disagree The ACS program increased my child knowledge of basic safety rules, and helped them identify traffic signs and understanding of how to behave safely and responsibly when walking or biking. ___ Strongly agree ___ Somewhat agree ____ Somewhat disagree ___ Strongly disagree The distance to school was significant barrier to letting my child walk or bike to school. ___ Strongly agree ___ Somewhat agree ____ Somewhat disagree ___ Strongly disagree The distance to school is ____Less than ½ mile ____Between ½ and a mile ____A mile ____Between 1½ and 2 miles ____Over 2 miles The ACS Education Program enhanced my child’s motivation/behavior to walk/bike to school or local destinations. ___ Strongly agree ___ Somewhat agree ____ Somewhat disagree ___ Strongly disagree I feel that the ACS Education program addressed my safety concerns and I would let my child commute to destinations close to my home (within 1 mile). ___ Strongly agree ___ Somewhat agree ____ Somewhat disagree ___ Strongly disagree The ACS program increasing my confidence and gave my child a better understanding of their streets and ensure that they know basic traffic safety, which will increase my willingness to allow my child to walk/bike to school or neighborhood locations. 106 ___ Strongly agree ___ Somewhat agree ____ Somewhat disagree ___ Strongly disagree Thank you for your participation in this ACS Educational Program! APPENDIX C ACTIVE COMMUTING TO SCHOOL EDUCATIONAL INTERVENTION 108 Active Commuting to School Educational Intervention Schedule Date September 11, 2017 September 18, 2017 September 25, 2017 October 2, 2017 October 16, 2017 October 23, 2017 October 30 November 6, 2017 November 8, 2017 Description Lesson 1 Welcome & Introduction: What is ACS? (Collection of Consent Forms & Questionnaires) Lesson 2 Be A Lert – Traffic Awareness Lesson 3 My Bicycle Lesson 4 Rules of the Road: Traffic Signs Lesson 5 Bicycle Helmet Safety Lesson 6 Class Review Post Intervention Data Collection Bike and Prize Drawing 109 ● ● ● ● ● ● ACS Lesson 1 ACS Introduction Power Point Passive commuting: Transportation that doesn’t require much exercise to get to where one is going, e.g. car, bus, and train. Active commuting: Transportation that is self-powered, e.g. walking, skating, and cycling. Pedestrian: a person who walks. Cyclist: a person who rides a bicycle. ACS Safety Guidelines: Rules or traffic patterns to follow to flow with traffic and be predictable. Physical Activity: Movement that activates your heart and muscles and makes you stronger, e.g. jump rope, swimming, walking, cycling. Classroom Activity—Working in Small Groups ● Students in small groups brainstorm and record lists of safety guidelines for pedestrians and cyclists. Half of the groups focus on bicycle safety and the other half focus on pedestrian safety. The groups record ideas to share with the whole class. ● Groups share their ideas with the whole class, and students fill in their lists with guidance from the Pedestrian and Bike Safety Guidelines page (http://www.pedbikeinfo.org/community/tips_bicyclist.cfm ,2017). Objectives 1. Students verbalize an example of active transportation and explain a benefit. 2. Students list two pedestrians and two bicycle safety guidelines. Homework Students complete safe walker worksheet (http://www.drivesmartcolorado.com/wpcontent/uploads/2013/08/activity-pedestrian-activity-sheets.pdf) with their parents. Data Collection and Incentives Data collection: Students return completed walking checklists, community walkability scales, child assent forms, parental permission forms, demographic forms, and Neighborhood Environmental Walkability Scale (NEWS). Incentives: To increase awareness and motivation for ACS on a weekly basis, children earn participation prizes (stickers, pencils, and pens) and entries for the free bicycle drawing at the end of the ACS program. Besides class participation, students also earn incentives by returning parent signed homework, permission forms and surveys. 110 ACS Lesson 2 Be A LERT/Traffic Power Point ★ More than 1600 children in the United States are killed in traffic accidents every year (asirt.org/initiatives/informing-road-users/road-safety-facts/road-crash-statistics ,2017). A Lert: a creature who is constantly aware of what is going on in its environment. Intersection: a place where two or more streets meet. Pedestrian: a person traveling on foot or in a wheelchair. Reflectivity: the quality of being visible when there is little light. Scan: to look in all directions. Shoulder: the space at the edge of a road or street. Sidewalk: a paved or unpaved walkway separated from traffic by a curb. Visibility: the ability to see or be seen. 1. Why must pedestrians walk facing traffic when there’s no sidewalk or path? (Pedestrians have a better chance to see vehicles coming from ahead than from behind.) 2. What makes a route safer for walking? (Well-maintained sidewalks and paths v. poorly maintained or none, Wide shoulders v. narrow or none, Light traffic v. heavy, Speed under 35mph v. over, Dark outside v. light, Straight street v. curvy or hilly, Clear air v. fog or smoke.) 3. What should a pedestrian do to prepare for walking in bad weather or at night? (When visibility is low, pedestrians should wear bright clothes with reflective materials. It is recommended that children do not walk when in conditions of low visibility, especially at night.) 4. How and where should children cross the street? (Where: At a corner, ideally where there is a marked crosswalk, or a WALK/DON’T WALK signal. How: (rhyme) Stop, look and listen, before you cross the street. First use your eyes and ears, then you use your feet! Classroom Creative Activity Students draw A Lert and write 2 rules it would follow. Pedestrian Rules ★ A Lert always walks on the sidewalks. ★ A Lert always dresses to be visible. ★ A Lert always scans both ways and listens before crossing. ★ A Lert always waits for the WALK signal, when there is one. ★ A Lert always walks facing traffic when there is no sidewalk. ★ A Lert always walks with a partner. The partner should be a parent, guardian, or grown-up friend approved by a parent/guardian. Objective: Students write two pedestrian rules A Lert would follow. Homework 111 Students share safest-route-to-school map and A LERT drawing with parent. Bring signed A LERT back for incentive. 112 ACS Lesson 3 My Bicycle Power Point Classroom Activities I. Students brainstorm reasons to ride: faster than walking, no gas (cost/pollution), fun, healthy, go places... II. Students recall “ABC Quick Check” Steps during Demonstration (https://bikeleague.org/content/basic-bike-check ,2017). “ABC Quick Check” (https://bikeleague.org/content/basic-bike-check , 2017). Air: Be sure you have enough air in your tires. Brakes: Look to see that your brake pads are not worn. Chain and Cranks: Pull on your cranks to see that they are not loose and look to see that the chain is not rusted and it is free of gunk. Quick Release: Make sure all quick releases are closed. Check: Take a slow brief ride to check that your bike is working properly. III. Students hold bicycle riders accountable for bicycle care. A bicycle is a vehicle with responsibilities like any other vehicle on the road! Bicycles should be cleaned and well maintained! Bicycle care prevents accidents due to faulty equipment. Objective Students demonstrate understanding of ABC Quick Check when demonstrator purposely makes mistakes by correcting her. Homework Students complete bike parts worksheet with their parents. (http://clipartlibrary.com/clipart/pcq9dBRc9.htm ,2017). 113 ACS Lesson 4 Rules of the Road: Traffic Signs Power Point Classroom activities I. Students identify traffic signs. 1. Students identify basic geometric shapes (circle, rectangle, square, triangle, octagon). 2. Students discuss familiar traffic signs and which shape they are. (www.trafficsign.us, 2017). II. Students demonstrate traffic sign usefulness by becoming make-believe vehicles and pedestrians in the classroom, using the lines on the floor for streets. Traffic Game Explanation: 1. The lines on the floor of the gym are streets. 2. The girls are all vehicles. Vehicles walk on the right side of lines, “driving,” putting their hands on imaginary steering wheels. Creativity is encouraged: make motor and horn noises and use hand turn signals. (Motorcycle is much louder. Buses have one driver. The “passengers” (no more than 2) put their hands on the shoulders of the person in front of them. 3. The boys are pedestrians. Pedestrians walk beside the street, facing traffic, because there are no sidewalks. Pedestrians stay out of the street (on the left side of the line). They also stop, look left, look right, and then look left again at every intersection before crossing. 4. To make the game more interesting, a randomly selected “road engineer” may go to a busy intersection and hold up a traffic light, so more cars can go at once. 5. Girls and boys switch to pedestrians and vehicles. 6. The game pauses every 2 minutes or so to make observations, switch passengers and vehicles, and randomly assign “road engineers.” Objective Students verbalize proper roadway pedestrian position and what a pedestrian should do at different traffic signs: stop sign, yield sign, red light, yellow light, green light, “Don’t Walk” signal, and “Walk” signal. Homework Students complete traffic sign homework sheet. (http://www.getcoloringpages.com/coloring/284082 ,2017). 114 Lesson 5 Bicycle Helmet Safety Power Point Classroom Activity I. Students discuss bicycle mortality statistics and wearing a helmet as a precaution. Almost three-quarters of fatal bicycle crashes (74%) involved a head injury (https://helmets.org/stats.htm, 2017). Nearly all bicyclists who died (97%) were not wearing helmets. (https://helmets.org/stats.htm, 2017). II. Students recall 5 steps for proper bicycle helmet fitting. (https://www.helmets.org/nhtsafit.pdf) 1. Helmet position should allow 2 fingers of space between eyebrows and helmet. 2. Left buckle centers under the chin. 3. Front and back sliders around ears are adjusted so the “v’s” are below the ears. 4. Buckled chin strap is tightened so that only 1 or 2 fingers can fit snug under strap. 5. Yawning should pull helmet down on the head. If not, repeat tightening (step 4). Objectives 1. Students verbalize that wearing bicycle helmets can prevent brain injury. 2. Students recall the 5 steps for properly fitting a bicycle helmet. Homework Students complete bicycle helmet worksheet. 115 Lesson 6 ACS Class Review & Objectives 1. Students differentiate between passive and active commuting. 2. Students verbalize 2 (A LERT) pedestrian safety guidelines. 3. Students verbalize advantages of riding a bicycle and recall the ABC Quick Check. 4. Students verbalize proper riding position on the road and recognize traffic signs. 5. Students verbalize that helmets can prevent brain injury and recall the steps to properly fit a bicycle helmet. Class Activity 1. Students draw a safe route to school picture with themselves actively commuting. 2. Students sign a safety pledge. 3. Students enjoy a chance to win a bicycle in the incentive drawing. 116 References Lesson 1. http://www.pedbikeinfo.org/community/tips_bicyclist.cfm ,2017. asirt.org/initiatives/informing-road-users/road-safety-facts/road-crash-statistics ,2017. http://www.drivesmartcolorado.com/wp-content/uploads/2013/08/activity-pedestrianactivity-sheets.pdf. Lesson 2. SRTS. “Be A Lert.” City of Fort Collins, Aug. 2017, www.fcgov.com/saferoutes/pdf/lesson16. Lesson 3. https://bikeleague.org/content/basic-bike-check ,2017. ABC Quick Check” (https://bikeleague.org/content/basic-bike-check , 2017. Lesson 4. http://clipart-library.com/clipart/pcq9dBRc9.htm ,2017. www.trafficsign.us ,2017. http://www.getcoloringpages.com/coloring/284082 ,2017. Lesson 5. https://helmets.org/stats.htm ,2017. Lesson 6. Safety Pledge.