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1 the Impact of Safety on Walk-To The Impact of Safety on Walk-to-School Behavior: Analysis of Local Safe Routes to School Program Data Dissertation Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate School of The Ohio State University By Katherine Swidarski Graduate Program in Public Health The Ohio State University 2018 Dissertation Committee Elizabeth Klein, PhD, MPH Phyllis Pirie, PhD Elisabeth Root, PhD, MPH 1 Copyrighted by Katherine Swidarski 2018 2 Abstract Introduction: Lack of physical activity and unintentional injury are leading causes of morbidity among children and associated with significant disadvantages physically, socially and academically. Safety barriers and parental perceptions of safety can prevent children from obtaining the benefits of daily physical activity, like walking to school. Programs that promote walking to school, such as the evidence-based Safe Routes to School (SRTS) program, can alleviate physical barriers to safety in the environment and increase opportunities for being active. Supportive SRTS policies at all levels of government can design safer streets and lead to institutionalization of the program. The purpose of this study is to better understand objective and perceived safety factors that influence walk to school behavior among elementary school families and assess how policies may impact the opportunity for children to safely walk to school. Methods: Multiple methods, motivated by a socioecological framework, were used to investigate safety factors, including speed of traffic, amount of traffic, sidewalk continuity, safety of intersections, and presence of registered sex offenders. Data on parental perceptions of safety (n=10,810) from cross-sectional SRTS surveys collected by a total of 82 schools in three locations, and corresponding objective safety from online repositories for the area within 1-mile of school locations, were used to quantify safety. First, spatial distribution of safety was explored through a combination of spatial and non-spatial analyses using location data for parents, schools and safety factors. Then, multi-level logistic regression models were built to identify factors associated with the outcome of walking to school. Finally, a review of local, regional, state and federal ii education and transportation policies was conducted to measure inclusion of child pedestrian language and seven effective policy components adapted from a SRTS guide. Results: Approximately half of parents’ perceptions were mismatched with the objective measure of safety for all factors except amount of traffic. All three programs had a high density of unsafe speed around schools, but the density of perceived lack of safety was consistent across factors and programs. Joint count analysis found spatial patterning of safety varied among SRTS programs. In logistic regression analyses, odds of walking to school (versus driving or using any other mode) changed significantly for a single unit increase/decrease in safety and salient safety factors differed across programs. Review of SRTS policies revealed no school level policies directly addressing walking to school as a form of transportation and an absence of pedestrian-specific language within policies at all levels. Policies were also frequently missing at least one component for more effectively providing opportunities for children to safely walk to school. Discussion: This study provides critical considerations about traffic, neighborhood and policy influences on safety. Objective and perceived safety need to be considered together to address barriers keeping children from safely walking to school. SRTS survey data can be useful in that process. These data reveal significant, location-specific factors that influence a family’s choice to walk. Results also indicate that policies need to be better designed to explicitly promote health and prevent injury of children. iii Dedication This document is dedicated to my family. iv Acknowledgments I would like to thank the committee, Dr. Klein, Dr. Pirie, and Dr. Root, for their guidance throughout the course of this research and for their enthusiasm toward the content. Many thanks to the local Safe Routes to School program team members in San Francisco, Miami-Dade County and Columbus for their efforts to create and promote safe routes for all. I also want to extend my gratitude to friends, staff, faculty, and fellow doctoral students across all Divisions of the College of Public Health for their assistance and tremendous support. v Vita June 2005 .......................................................Cuyahoga Heights High School 2009................................................................B.A. Psychology, University of Rochester 2011................................................................M.P.H Epidemiology, University of Miami 2015 to 2017 ..................................................Graduate Teaching Associate, Department of Health Behavior and Health Promotion, The Ohio State University Publications McAdams RJ, Swidarski K, Clark RM, Roberts KJ, Yang J, Mckenzie LB. Bicycle- related injuries among children treated in US emergency departments, 2006-2015. Accid Anal Prev 2018;118:11–7. doi:10.1016/j.aap.2018.05.019. Fields of Study Major Field: Public Health vi Table of Contents Abstract ............................................................................................................................... ii Dedication .......................................................................................................................... iv Acknowledgments............................................................................................................... v Vita ..................................................................................................................................... vi Publications ........................................................................................................................ vi Fields of Study ................................................................................................................... vi List of Tables ................................................................................................................... xiii List of Figures ................................................................................................................... xv Chapter 1. Introduction ....................................................................................................... 1 Background and Significance ......................................................................................... 1 Knowledge Gap .............................................................................................................. 5 Structure of the Dissertation ........................................................................................... 9 Chapter 2. Background and Literature Overview ............................................................ 11 Research Design and Methods of Previous Studies ...................................................... 11 Safe Routes to School ................................................................................................... 15 Spatial Analyses ............................................................................................................ 20 Multilevel Analyses ...................................................................................................... 22 vii Parental Perceptions of Traffic and Neighborhood Safety ........................................... 25 Traffic Safety Barriers for Walking to School .............................................................. 27 Neighborhood Safety Barriers for Walking to School .................................................. 30 Personal Correlates of Walking to School .................................................................... 31 Other Correlates of Walking to School ......................................................................... 33 Role of Policy to Support Promotion of Walking to School ........................................ 34 Summary of Literature .................................................................................................. 36 Chapter 3. Overview of Research Framework, Data Sources and Approaches ................ 42 Conceptual and Theoretical Frameworks ..................................................................... 42 Social Ecological Model ........................................................................................... 47 Hierarchy of Walking Needs .................................................................................... 47 Social Cognitive Theory ........................................................................................... 51 Broken Windows Theory of Urban Decline ............................................................. 51 Specific Aims ................................................................................................................ 53 Study Design ................................................................................................................. 54 Study Sample ................................................................................................................ 54 San Francisco Safe Routes to School, San Francisco, California ............................. 57 WalkSafe Program, Miami-Dade County, Florida ................................................... 57 Columbus Safe Routes, Columbus, Ohio ................................................................
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