County Health Rankings & Roadmaps, A Healthier Nation, County by County

The County Health Rankings models and measures

Our Approach

The County Health Rankings model of population health

What can I do?

Action Center

Explore guides and tools for improving health.

What Works for Health

Explore programs and policies that work!

What can I learn from others?

Reports

Key findings from the last four years of County Health Rankings and other national reports.

County-by-County Blog

Project updates, commentaries, events and news about health across the nation from the County Health Rankings & Roadmaps team.

Safe Routes to Schools

Safe Routes to Schools (SRTS) is a federally supported program that promotes walking and biking to school through education and incentives. The program also supports city planning and legislative efforts to make walking and biking safer and provides resources and activities to help communities build sidewalks, bicycle paths, and other pedestrian-friendly infrastructure (NCSRTS-History).

Expected Beneficial Outcomes (Rated)

  • Increased active transportation

Other Potential Beneficial Outcomes

  • Increased physical activity

  • Improved health outcomes

  • Increased pedestrian and cyclist safety

  • Reduced emissions

  • Reduced vehicle miles traveled

Evidence of Effectiveness

There is strong evidence that Safe Routes to Schools (SRTS) increases the number of students walking or biking to school (Chillon 2011, SRTSNP-Hubsmith 2007, Orenstein 2007, Boarnet 2005, NCSRTS 2012, , , , , Ragland 2014, Hoelscher 2016). Improvements to pedestrian or bicycle transportation systems and environmental design interventions, which can be supported by SRTS, have been shown to increase physical activity (CG-Physical activity). SRTS is a suggested strategy to increase physical activity among students (US GAO-Siggerud 2008, ALBD, WIPAN-Schools). 

Active travel to school is associated with healthier body composition, cardio fitness levels (Lubans 2011), and increases in moderate to vigorous physical activity (MVPA) (). SRTS has a small positive effect on active travel among children (Chillon 2011, ). By improving walking and bicycling routes, SRTS projects in urban areas may also increase physical activity levels for adults (Watson 2008), and may help introduce bicycling in communities where it is not common ().

SRTS projects, especially sidewalk improvements, can improve pedestrian safety (Ragland 2014). SRTS has been shown to reduce pedestrian crashes and injuries (), especially for school-age children () during school commute hours (DiMaggio 2014, DiMaggio 2013).

Replacing automotive trips with biking and walking can reduce vehicle miles traveled (VMT) and greenhouse gas emissions that contribute to climate change at relatively low cost, although the long-term effect on traffic reduction is likely minor (RAND-Sorenson 2008, ). Surveys of parents who drive their children less than two miles to school indicate that convenience and time saving are key reasons for driving; SRTS may not be able to address these constraints (McDonald 2009). Safety and security concerns can also discourage parents from allowing students to walk or bike to school (Nasrudin 2013); insufficient or inexperienced volunteers, lack of funding, and difficulties maintaining partnerships can also be challenges for programs in urban or rural areas ().

In a New York City-based cost-effectiveness study, SRTS saved money over the long term, and was associated with a large net benefit for society (). Nationally, SRTS programs with public investments in walking and bicycling infrastructure can reduce transportation expenditures for school districts and families. SRTS programs are most cost-effective for schools with a large number of children living within walking distance ().

Multidisciplinary, collaborative partnerships increase community support, knowledge and problem solving capacity, coordination, and funding opportunities to support successful SRTS efforts (). 

Impact on Disparities

No impact on disparities likely

Implementation Examples

Safe Routes to Schools (SRTS) programs operate in all 50 states and Washington DC, in urban, suburban, and rural communities with varying income levels (NCSRTS-History). Every state Department of Transportation (DOT) manages and administers the state SRTS program, and appoints a full-time SRTS coordinator. The level of SRTS implementation varies by state (NCSRTS-State contacts). Several state legislatures have established additional guidelines for allocating federal SRTS funding, as in California, and for incorporating SRTS principles into school wellness policies and transportation plans, as in Massachusetts (NCSL-Shinkle 2012).

The National Highway Traffic Safety Administration (NHTSA) highlights several examples of cities and states with promising SRTS efforts for communities to replicate, including Arlington and Boston, Massachusetts; Chicago, Illinois; Portland, Oregon; Florida; and Santa Ana, California (NHTSA-SRTS guide). 

Implementation Resources

NCSRTS - Safe Routes. National Center for Safe Routes to School (NCSRTS).

SRTSNP-Gavin 2010 - Gavin K, Pedroso M. Implementing Safe Routes to School in low-income schools and communities: A resource guide for volunteers and professionals. Fairfax: Safe Routes to School National Partnership (SRTSNP); 2010.

WisDOT-SRTS toolkit 2007 - Wisconsin Department of Transportation (WisDOT). Wisconsin Safe Routes to School (SRTS) toolkit. 2007.

ChangeLab-SRTS - ChangeLab Solutions. Safe Routes to School (SRTS).

AHA-VFHK toolkits - American Heart Association (AHA), Robert Wood Johnson Foundation (RWJF). Voices for healthy kids (VFHK): Toolkits to make the healthy choice the easy choice in the places where children live, learn and play.

CDC-DNPAO data - Centers for Disease Control and Prevention (CDC), Division of Nutrition Physical Activity and Obesity (DNPAO). Nutrition, physical activity and obesity: Data, trends and maps online tool.

LHC-Rockeymoore 2014 - Rockeymoore M, Moscetti C, Fountain A. Rural Childhood Obesity Prevention Toolkit. Leadership for Healthy Communities (LHC). 2014.

US DOT-PBIC Sidewalks - US Department of Transportation (US DOT), Federal Highway Administration (FHWA). Pedestrian and Bicycle Information Center (PBIC). Sidewalks and walkways.

HOST-PA - Healthy Out-of-School Time (HOST) Coalition. Resources: Physical activity (PA).

NHTSA-SRTS guide - National Highway Traffic Safety Administration (NHTSA). Safe Routes to School (SRTS): Practice and Promise.

Citations - Evidence

* Journal subscription may be required for access.

SRTSNP-Hubsmith 2007 - Hubsmith D, Ping R, Gutowsky N. Safe Routes to School: 2007 State of the states report. Fairfax: Safe Routes to School National Partnership (SRTSNP); 2007.

WIPAN-Schools - Wisconsin Nutrition and Physical Activity Program (WIPAN). What works in schools.

ALBD - Active Living by Design (ALBD). Increasing physical activity and healthy eating through community design.

CG-Physical activity - The Guide to Community Preventive Services (The Community Guide). Physical activity.

US GAO-Siggerud 2008 - Siggerud K. Safe Routes to School: Progress in implementing the program, but a comprehensive plan to evaluate program outcomes is needed. Washington, DC: US Government Accountability Office (US GAO); 2008: GAO-08-789.

RAND-Sorenson 2008 - Sorenson P, Wachs M, Min EY, et al. Moving Los Angeles: Short-term policy options for improving transportation. Santa Monica: RAND Corporation; 2008: Monograph Report 748.

Wendel 2009* - Wendel AM, Dannenberg AL. Reversing declines in walking and bicycling to school. Preventive Medicine. 2009;48(6):513-5.

Orenstein 2007 - Orenstein MR, Gutierrez N, Rice TM, Cooper JF, Ragland DR. Safe routes to school safety and mobility analysis. Berkeley: UC Berkeley, Traffic Safety Center, California Department of Transportation (Caltrans); 2007.

Boarnet 2005 - Boarnet MG, Anderson CL, Day K, McMillan T, Alfonzo M. Evaluation of the California safe routes to school legislation: Urban form changes and children’s active transportation to school. American Journal of Preventive Medicine. 2005;28(2 Suppl 2):134-40.

NCSRTS 2012 - National Center for Safe Routes to School (NCSRTS). Shifting modes: A comparative analysis of Safe Routes to School Program elements and travel mode outcomes. Chapel Hill: National Center for Safe Routes to School (NCSRTS); 2012.

Lubans 2011 - Lubans DR, Boreham CA, Kelly P, Foster CE. The relationship between active travel to school and health-related fitness in children and adolescents: A systematic review. International Journal of Behavioral Nutrition and Physical Activity. 2011;8:5.

Chillon 2011 - Chillón P, Evenson KR, Vaughn A, Ward DS. A systematic review of interventions for promoting active transportation to school. International Journal of Behavioral Nutrition and Physical Activity. 2011;8:10.

Watson 2008 - Watson M, Dannenberg AL. Investment in Safe Routes to School projects: Public health benefits for the larger community. Preventing Chronic Disease. 2008;5(3).

Dumbaugh 2007* - Dumbaugh E, Frank L. Traffic safety and safe routes to schools: Synthesizing the empirical evidence. Transportation Research Record: Journal of Transportation Research Board. 2007;2009(1):89-97.

McDonald 2009 - McDonald NC, Aalborg AE. Why parents drive children to school: Implications for Safe Routes to School programs. Journal of the American Planning Association. 2009;75(3):331-42.

Bassett 2013* - Bassett DR, Fitzhugh EC, Heath GW, et al. Estimated energy expenditures for school-based policies and active living. American Journal of Preventive Medicine. 2013;44(2):108-13.

Salon 2012* - Salon D, Boarnet MG, Handy S, Spears S, Tal G. How do local actions affect VMT? A critical review of the empirical evidence. Transportation Research Part D: Transport and Environment. 2012;17(7):495–508.

McDonald 2014* - McDonald NC, Steiner RL, Lee C, et al. Impact of the Safe Routes to School program on walking and bicycling. Journal of the American Planning Association. 2014;80(2):153-167.

McDonald 2016* - McDonald NC, Steiner RL, Palmer WM, et al. Costs of school transportation: Quantifying the fiscal impacts of encouraging walking and bicycling for school travel. Transportation. 2016;43(1):159-175.

McDonald 2013* - McDonald NC, Yang Y, Abbott SM, Bullock AN. Impact of the Safe Routes to School program on walking and biking: Eugene, Oregon study. Transport Policy. 2013;29:243-248.

DiMaggio 2016* - DiMaggio C, Frangos S, Li G. National Safe Routes to School program and risk of school-age pedestrian and bicyclist injury. Annals of Epidemiology. 2016;26(6):412-417.

DiMaggio 2014 - DiMaggio C, Chen Q, Muennig PA, Li G. Timing and effect of a safe routes to school program on child pedestrian injury risk during school travel hours: Bayesian changepoint and difference-in-differences analysis. Injury Epidemiology. 2014;1(1):17.

DiMaggio 2013 - DiMaggio C, Li G. Effectiveness of a Safe Routes to School Program in preventing school-aged pedestrian injury. Pediatrics. 2013;131(2):290-296.

Muennig 2014* - Muennig PA, Epstein M, Li G, DiMaggio C. The cost-effectiveness of New York City’s Safe Routes to School program. American Journal of Public Health. 2014;104(7):1294-1299.

Stewart 2014* - Stewart O, Moudon AV, Claybrooke C. Multistate evaluation of Safe Routes to School programs. American Journal of Health Promotion. 2014;28(3 Suppl):S89-S96.

Ragland 2014 - Ragland DR, Pande S, Bigham J, Cooper JF. Ten years later: Examining the long-term impact of the California Safe Routes to School program. Berkeley, CA: Safe Transportation Research & Education Center (SafeTREC); 2014.

Macridis 2015* - Macridis S, García Bengoechea E. Adoption of Safe Routes to School in Canadian and the United States contexts: Best practices and recommendations. Journal of School Health. 2015;85(8):558-566.

Nasrudin 2013 - Nasrudin N, Nor ARM. Travelling to school: Transportation selection by parents and awareness towards sustainable transportation. Procedia Environmental Sciences. 2013;17:392-400.

Hoelscher 2016 - Hoelscher D, Ory M, Dowdy D, et al. Effects of funding allocation for Safe Routes to School Programs on active commuting to school and related behavioral, knowledge, and psychosocial outcomes: Results from the Texas Childhood Obesity Prevention Policy Evaluation (T-COPPE) study. Environment and Behavior. 2016;48(1):210-229.

Citations - Implementation Examples

* Journal subscription may be required for access.

NCSL-Shinkle 2012 - Shinkle D. Bicycle and pedestrian safety: Transportation review. National Conference of State Legislatures (NCSL). 2012.

NHTSA-SRTS guide - National Highway Traffic Safety Administration (NHTSA). Safe Routes to School (SRTS): Practice and Promise.

NCSRTS-History - National Center for Safe Routes to School (NCSRTS). History of SRTS.

NCSRTS-State contacts - National Center for Safe Routes to School (NCSRTS). Find state contacts.

Date Last Updated

May 25, 2017