Complete Streets & streetscape design initiatives

Evidence Rating  
Scientifically Supported
Evidence rating: Scientifically Supported

Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.

Health Factors  
Community in Action

Houghton MI implements Complete Streets

Fri, 12/27/2019 - 19:39

To increase physical activity in a rural region with high rates of unemployment and poverty, and lots of snow, Michigan’s Western Upper Peninsula Health...

Streetscape design improvements enable pedestrians, bicyclists, transit riders, and motorists to share and use the street, accommodating the needs of all users. Improvements to streetscape design can include increased street lighting, enhanced street landscaping and street furniture, increased sidewalk coverage and connectivity of pedestrian walkways, bicycling infrastructure, street crossing safety features, and traffic calming measures. Streetscape design improvement projects typically include elements from more than one of these categories; these projects can be implemented incrementally or comprehensively, and are often part of community-level Complete Streets policies1.

Expected Beneficial Outcomes (Rated)

  • Increased physical activity

  • Increased pedestrian and cyclist safety

Other Potential Beneficial Outcomes

  • Increased active transportation

  • Reduced obesity rates

  • Improved sense of community

  • Improved neighborhood safety

  • Reduced stress

  • Reduced vehicle miles traveled

Evidence of Effectiveness

There is strong evidence that streetscape design improvements, often implemented via Complete Streets initiatives, increase physical activity, particularly as part of a multi-component land use approach2, 3. Street crossing safety features and traffic calming measures, often components of streetscape design improvements, have also been shown to reduce traffic speed and increase pedestrian and cyclist safety2, 4, 5, 6, 7, 8, 9, 10.

Street-scale urban design projects can provide safer, more inviting environments for outdoor physical activities2. Features such as street furniture, street-facing windows, and active street frontages are also associated with increased pedestrian street use11, and traffic calming features can increase walking and bicycling12, 13. Living in neighborhoods with greater street connectivity, more streetlights and bike paths, and related environmental characteristics is associated with higher levels of walking, increased physical activity, and lower rates of overweight and obesity14, 15, 16. Environmental improvements that make neighborhoods more walkable are also associated with lower body mass indexes (BMIs) among children17.

Connected sidewalks, street crossing safety features, and bicycle lanes can reduce injury risk for pedestrians and cyclists15. Narrower streetscapes may encourage slower driving than large, open streetscapes, improving both livability and safety18. Streetscape design improvements may also improve green space, increase sense of community, and reduce crime and stress2. A New York City-based study, for example, suggests that streetscape design elements, especially tree canopy coverage, increase perceptions of safety19.

Complete Streets with light rail public transit can increase physical activity for new riders20. Efforts to connect different forms of transit and enhance pedestrian and bicycle commuting infrastructure may encourage transit use and help riders easily travel the last mile to a destination21.

Replacing automotive trips with biking and walking can reduce vehicle miles traveled (VMT) and greenhouse gas emissions that contribute to climate change22, 23. Activity friendly environments such as streetscapes with greater street connectivity and access, more greenery and trees, proximity to parks, and mixed land use can also increase environmental sustainability and enhance economic activity24, 25, and may increase employment and nearby property values26.

Research suggests that clear initiative definition, efforts to educate the public, advocates, and decision-makers, and strong and diverse networks of supporters can help further adoption of local Complete Streets policies27.

Costs for infrastructure improvements vary significantly both by locale and type of improvement, for example the median cost is $340 for a striped crosswalk, $16 per linear foot for an asphalt sidewalk, and $89,470 per mile for a bike lane28. Streetscape design improvements typically have a lower cost per mile than the cost per mile for an average new arterial street project26.

Impact on Disparities

No impact on disparities likely

Implementation Examples

As of 2016, over 1,100 Complete Streets policies have been adopted at the local, regional, and state level1. Urbanized states are more likely to have adopted Complete Streets policies29; such policies are less prevalent in smaller communities with lower median education levels and communities in the South30. The National Complete Streets Coalition and Smart Growth America highlight 10 best Complete Streets policies of 2012 in a 2013 report31. Active Living By Design and Active Living Research also highlight many communities implementing Complete Streets policies and individual streetscape design improvements32, 33.

Walk Friendly Communities is a national recognition program that supports and encourages efforts to enhance safer walking environments, which include streetscape design improvements. Walk Friendly Communities have been recognized at various levels in 29 states. Seattle and New York City have been recognized at the platinum level; 15 communities have been recognized as gold, 18 as silver, 31 as bronze, and 22 as honorable mentions34.

London, Kentucky is an example of a city working to improve streetscape design with additional bicycling infrastructure and connecting walking routes that incorporate streetscape beautification, parks, urban greening efforts, as well as local public art displays35.

Implementation Resources

UNC-Bushell 2013 - Bushell MA, Poole BW, Zegeer CV, Rodriguez DA. Costs for pedestrian and bicyclist infrastructure improvements: A resource for researchers, engineers, planners, and the general public. Chapel Hill: University of North Carolina, Chapel Hill, Highway Safety Research Center; 2013.

Gilpin 2012 - Gilpin J, Costakis C. Montana Complete Streets toolkit: For cities, small towns and tribal communities. Bozeman: Alta Planning + Design, Montana Nutrition and Physical Activity Program (NAPA), Montana Department of Public Health and Human Services (DPHHS); 2012.

SGA-Complete Streets - Smart Growth America (SGA). National Complete Streets Coalition resources.

WHO-E-Edwards 2008 - Edwards P, Tsouros AD. A healthy city is an active city: A physical activity planning guide. Copenhagen, DK: World Health Organization Europe (WHO-E); 2008.

LHC-Toolkit 2009 - Leadership for Healthy Communities (LHC). Action strategies toolkit: A guide for local and state leaders working to create healthy communities and prevent childhood obesity. Princeton: Robert Wood Johnson Foundation (RWJF); 2009.

NCSC-Seskin 2013 - Seskin S, Gordon-Koven L. The best Complete Streets policies of 2012. Washington, DC: National Complete Streets Coalition (NCSC), Smart Growth America (SGA); 2013.

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

ChangeLab-Zimmerman 2013 - Zimmerman S, Kramer K. Getting the wheels rolling: A guide to using policy to create bicycle friendly communities. Oakland: ChangeLab Solutions; 2013.

ChangeLab-CS - ChangeLab Solutions. What are Complete Streets (CS)?

Schlossberg 2013* - Schlossberg M, Rowell J. Rethinking streets: An evidence based design manual on making streets into Complete Streets. Portland, OR: National Institute for Transportation and Communities (NITC); 2013.

Ranahan 2014 - Ranahan ME, Lenker JA, Maisel JL. Evaluating the impact of Complete Streets initiatives. Center for Inclusive Design and Environmental Access (IDEA). University at Buffalo, the State University of New York. 2014.

LHC-Rockeymoore 2014 - Rockeymoore M, Moscetti C, Fountain A. Rural childhood obesity prevention toolkit. Leadership for Healthy Communities (LHC), Center for Global Policy Solutions, Robert Wood Johnson Foundation; 2014.

AHA-VFHK toolkits - American Heart Association (AHA). Voices for healthy kids (VFHK): Resources and toolkits.

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.

PAS-Zoning 2016 - Planning Advisory Service (PAS). Planning & zoning for health in the built environment. American Planning Association (APA); 2016.

SRTSNP-Safe routes to healthy foods - Safe Routes to School National Partnership (SRTSNP). Healthy communities: Safe routes to healthy foods.


* Journal subscription may be required for access.

1 SGA-Complete Streets - Smart Growth America (SGA). National Complete Streets Coalition resources.

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

3 Brownson 2006* - Brownson RC, Haire-Joshu D, Luke DA. Shaping the context of health: A review of environmental and policy approaches in the prevention of chronic diseases. Annual Review of Public Health. 2006;27:341-70.

4 Cochrane-Bunn 2003* - Bunn F, Collier T, Frost C, et al. Area-wide traffic calming for preventing traffic related injuries. Cochrane Database of Systematic Reviews. 2003;(1):CD003110.

5 Cochrane-Beyer 2009* - Beyer FR, Ker K. Street lighting for preventing road traffic injuries. Cochrane Database of Systematic Reviews. 2009;(1):CD004728.

6 Rothman 2015 - Rothman L, Macpherson A, Buliung R, et al. Installation of speed humps and pedestrian-motor vehicle collisions in Toronto, Canada: A quasi-experimental study. BMC Public Health. 2015;15(1):774.

7 Cochrane-Aeron-Thomas 2005* - Aeron-Thomas A, Hess S. Red-light cameras for the prevention of road traffic crashes. Cochrane Database of Systematic Reviews. 2005;(2):CD003862.

8 Morrison 2003* - Morrison DS, Petticrew M, Thomson H. What are the most effective ways of improving population health through transport interventions? Evidence from systematic reviews. Journal of Epidemiology and Community Health. 2003;57(5):327-33.

9 Retting 2003 - Retting RA, Ferguson SA, McCartt AT. A review of evidence-based traffic engineering measures designed to reduce pedestrian-motor vehicle crashes. American Journal of Public Health. 2003;93(9):1456-63.

10 MN DOT-Stine 2014 - Stine P, Holdhusen B, Noyce D. Safety impacts of implementing Complete Streets. Minnesota Department of Transportation (MN DOT), Research Services & Library, Local Road Research Board (LRRB). Technical Summary:2013-2031TS. 2014.

11 Ewing 2016 - Ewing R, Hajrasouliha A, Neckerman KM, Purciel-Hill M, Greene W. Streetscape features related to pedestrian activity. Journal of Planning Education and Research. 2016;36(1):5-15.

12 Winters 2010 - Winters M, Brauer M, Setton EM, Teschke K. Built environment influences on healthy transportation choices: Bicycling versus driving. Journal of Urban Health. 2010;87(6):969-993.

13 Morrison 2004 - Morrison DS, Thomson H, Petticrew M. Evaluation of the health effects of a neighbourhood traffic calming scheme. Journal of Epidemiology and Community Health. 2004;58(10):837-40.

14 Wilson 2011a* - Wilson LA, Giles-Corti B, Burton NW, et al. The association between objectively measured neighborhood features and walking in middle-aged adults. American Journal of Health Promotion. 2011;25(4):e12-21

15 Reynolds 2010 - Reynolds CCO, Winters M, Ries FJ, Gouge B. Active transportation in urban areas: Exploring health benefits and risks. Vancouver: National Collaborating Centre for Environmental Health (NCCEH); 2010.

16 Lee 2012b - Lee RE, Mama SK, Medina A V, Ho A, Adamus HJ. Neighborhood factors influence physical activity among African American and Hispanic or Latina women. Health & Place. 2012;18(1):63-70.

17 Duncan 2014 - Duncan DT, Sharifi M, Melly SJ, et al. Characteristics of walkable built environments and BMI z-scores in children: Evidence from a large electronic health record database. Environmental Health Perspectives. 2014;122(12):1359-1365.

18 Harvey 2015a* - Harvey C, Aultman-Hall L. Urban streetscape design and crash severity. Transportation Research Record: Journal of the Transportation Research Board. 2015;2500:1-8.

19 Harvey 2015* - Harvey C, Aultman-Hall L, Hurley SE, Troy A. Effects of skeletal streetscape design on perceived safety. Landscape and Urban Planning. 2015;142:18-28.

20 Brown 2015a* - Brown BB, Werner CM, Tribby CP, Miller HJ, Smith KR. Transit use, physical activity, and body mass index changes: Objective measures associated with complete street light-rail construction. American Journal of Public Health. 2015;105(7):1468-1474.

21 Zellner 2016 - Zellner M, Massey D, Shiftan Y, Levine J, Arquero MJ. Overcoming the last-mile problem with transportation land-use improvements: An agent-based approach. International Journal of Transportation. 2016;4(1):1-26.

22 US EPA-Kramer 2013 - Kramer MG. Our built and natural environments: A technical review of the interactions among land use, transportation, and environmental quality. Washington, DC: US Environmental Protection Agency (US EPA); 2013.

23 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.

24 Sallis 2015 - Sallis JF, Spoon C, Cavill N, et al. Co-benefits of designing communities for active living: An exploration of literature. International Journal of Behavioral Nutrition and Physical Activity. 2015;12(1):1-10.

25 Perk 2015 - Perk V, Catalá M, Mantius M, Corcoran K. Capturing the benefits of Complete Streets. Tampa, FL: National Center for Transit Research (NCTR), Center for Urban Transportation Research (CUTR), University of South Florida (USF); 2015.

26 Anderson 2015* - Anderson G, Searfoss L, Cox A, et al. Safer streets, stronger economies: Complete Streets project outcomes from across the United States. Institute of Transportation Engineers ITE Journal. 2015;85(6):29-36.

27 Dodson 2014 - Dodson EA, Langston M, Cardick LC, et al. “Everyone should be able to choose how they get around”: How Topeka, Kansas, passed a Complete Streets resolution. Preventing Chronic Disease. 2014;11:130292.

28 UNC-Bushell 2013 - Bushell MA, Poole BW, Zegeer CV, Rodriguez DA. Costs for pedestrian and bicyclist infrastructure improvements: A resource for researchers, engineers, planners, and the general public. Chapel Hill: University of North Carolina, Chapel Hill, Highway Safety Research Center; 2013.

29 Yusuf 2016* - Yusuf JE, O’Connell L, Rawat P, Anuar K. Becoming more complete: The diffusion and evolution of state-level Complete Streets policies. Public Works Management & Policy. 2016;21(3):280-295.

30 Carlson 2016* - Carlson SA, Paul P, Kumar G, et al. Prevalence of Complete Streets policies in US municipalities. Journal of Transport & Health. 2016.

31 NCSC-Seskin 2013 - Seskin S, Gordon-Koven L. The best Complete Streets policies of 2012. Washington, DC: National Complete Streets Coalition (NCSC), Smart Growth America (SGA); 2013.

32 HPBD - Healthy Places by Design (HPBD). Advances community-led action and proven, place-based strategies to ensure health and wellbeing for all.

33 ALR-Complete Streets - Active Living Research (ALR). Promoting activity-friendly communities: Complete Streets.

34 WFC-State map - Walk Friendly Communities (WFC), Pedestrian and Bicycle Information Center. Walk friendly communities state map.

35 Gilboy 2016 - Gilboy ET, Philen M, Browning L, et al. London, KY: Turning London green: Conceptual designs for the expansion of London’s streetscape and greenspaces. Blacksburg, VA: Community Design Assistance Center (CDAC); 2016.

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