Safe Routes to School (SRTS)
Interventions Changing the Context
- School-based Programs to Increase Physical Activity
- School-Based Violence Prevention
- Safe Routes to School (SRTS)
- Motorcycle Injury Prevention
- Tobacco Control Interventions
- Access to clean syringes
- Pricing Strategies for Alcohol Products
- Multi-Component Worksite Obesity Prevention
- Early Childhood Education
- Clean Diesel Bus Fleets
- Public Transportation System: Introduction or Expansion
- Home Improvement Loans and Grants
- Earned Income Tax Credits
- Water Fluoridation
- Public Health Innovator’s Story: Safe Routes to School
- The Community Guide: Physical Activity: Interventions to Increase Active Travel to Schoolexternal icon
- BE Active: Connecting Routes + Destinations
- CDC’s Community Strategies for Physical Activity
- CDC’s Safe Youth. Safe Schools
- Safe Routes to School National Partnershipexternal icon
- Change Lab Solutionsexternal icon
What is Safe Routes to School (SRTS)?
Safe Routes to School (SRTS) encourages increased student physical activity through safe and active transport to and from school. SRTS promotes walking, bicycling, or other forms of active transportation among students and their families.[1, 2] SRTS can include educating the community and improving the built environment to ensure safe places for children and adolescents to walk and bike to and from school.[1, 2] Key elements of SRTS include:
- City planning and engineering approaches to transportation that address built environment needs and ensure safe conditions for walking and biking
- Tools, guides, and resources to encourage participation in safe and active transport
- Educational activities for students, parents, and community members about rules of the road and traffic safety
- Enforcement approaches to encourage safety and reduce unsafe behaviors among drivers, bicyclists, and pedestrians
- Evaluation activities to monitor and measure the impact of these programs. 
SRTS can be implemented at the state, community, or local school district level.[4-6] Competitive federal funding is available through the Fixing America’s Surface Transportation Act or the FAST Actexternal icon.[1, 7, 8] Depending on existing infrastructure, SRTS may require that education, transportation, public safety, and city planning agencies coordinate their efforts.[1, 3, 9] The Safe Routes to School National Partnership has produced State Report Cards detailing efforts nationwide. Program implementation that emphasizes partnerships has the ability to not only engage schools and communities, but create a cultural shift. Specifically, involvement of various stakeholders can help with multilevel planning and coordination of resources, which can help to reduce the burden on schools and their staff.
What is the public health issue?
Physical activity is an important contributor to health, and engaging in regular physical activity can improve cardiorespiratory and muscular fitness, bone health, cardiovascular and metabolic health markers and body composition in children and adolescents, and reduce the risk for numerous adverse health outcomes, including hypertension, diabetes, heart disease, and some cancers in adulthood. In 2008 the U.S. Department of Health and Human Services (HHS) recommended that young people aged 6-17 years participate in at least 60 minutes of physical activity daily. Physical activity also is an important factor in achieving a healthy weight and maintaining it over time.  Currently, 18.4 percent of children aged 6-11 years and 20.5 percent of adolescents age 12-19 years have obesity. Walking or bicycling for transportation increases physical activity. However, the proportion of students in grades K-8 who walk or bike to school fell from 47.7 percent in 1969 to only 12.7 percent in 2009.
What is the evidence of health impact and cost effectiveness?
SRTS programs are associated with increased active transportation, including an increase in the number of students walking or biking to and from school.[4, 14-18] Over a 3-year period, a comparative analysis based upon a national sample of school SRTS programs found that SRTS was associated with:
- An increase in the percentage of students who walked to and from school from 7-8 percent to 15-16 percent 
- An increase in the percentage of students who biked to and from school from one percent to two percent 
A 2014 evaluation of state-level SRTS projects in Floridaexternal icon, Mississippiexternal icon, Washingtonexternal icon, and Wisconsinexternal icon found that they were associated with significant increases in: active school travel (from 12.9 percent to 17.6 percent), walking (from 9.8 percent to 14.2 percent) and bicycling (from 2.5 percent to 3.0 percent). SRTS efforts can be even more important for subpopulations such as children with a disability or those that live in low-income neighborhoods.
Although the evidence for active transport overall is mixed, travel to and from school by bicycle has been associated with increased cardiorespiratory fitness levels among students.[18, 19,21] By improving the environment for walking and bicycling in urban areas, SRTS could also contribute to increased physical activity among adults and reductions in injuries involving pedestrian and bicyclist collisions. [22-24]
An analysis in New York City found that SRTS roadway modifications such as installing new traffic and pedestrian signals, were associated with reductions in childhood and overall injury rates and were projected to result in a net societal benefit of $230 million over the 50-year useful life of the modifications. For the sake of comparison, in 2017, the federal government allocated $835 million to the Transportation Alternatives Program, which provides funding to help local governments build bicycle and pedestrian improvements.That means that each year, the US spends seven times as much money on medical costs alone to treat people killed or injured while walking and biking than it does on preventing those deaths and injuries through putting in sidewalks, crosswalks, bike lanes, and other infrastructure that keeps people safe.
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- National Center for Safe Routes to School. National center for safe routes to school. 2016; Available at: National Center for Safe Routes to Schoolexternal icon. Accessed June 2.
- Robert Wood Johnson Foundation University of Wisconsin Population Center. County health rankings & roadmaps: Safe routes to schools (srts). 2015; Available at: Safe Routes to Schoolsexternal icon. Accessed November 30.
- Safe Routes to School National Partnership. The 6 e’s. 2018; Available at: The 6 E’s. Accessed July 10, 2018.
- McDonald NC, Steiner RL, Lee C, Rhoulac Smith T, Zhu X, Yang Y. Impact of the safe routes to school program on walking and bicycling. Journal of the American Planning Association. 2014;80(2):153-167.
- National Center for Safe Routes to School. Community success stories. 2016; Available at Community Success Storiesexternal icon. Accessed June 2.
- North Carolina Department of Transportation. North carolina safe routes to school. In: Transportation NCDo, ed. ncdot.gov: North Carolina Department of Transportation.
- Safe Routes to School National Partnership. Fast act background and resources. 2018; Available at: FAST Act Background and Resources. Accessed July 10, 2018.
- Moving ahead for progress in the 21st century act, (2012).
- National Center for Safe Routes to School. Advancing safe walking and bicycling for youth. In: U.S. Department of Transportation FHA, ed. saferoutesinfo.org: U.S. Department of Transportation; 2016.
- Soultana M, Enrique GB. 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.
- U.S. Department of Health and Human Services. Physical activity guidelines for Americans. In: U.S. Department of Health and Human Services, ed2008.
- Hales CM, Fryar CD, Carroll MD, Freedman DS, Ogden CL. Trends in obesity and severe obesity prevalence in us youth and adults by sex and age, 2007-2008 to 2015-2016. Jama. 2018;319(16):1723-1725.
- Centers for Disease Control and Prevention. MMWR: Morbidity and
mortality weekly report. 2005; 54(38):949-952
- McDonald NC, Brown AL, Marchetti LM, Pedroso MS. US school travel, 2009: an assessment of trends. Am J Prev Med 2011;41(2):146–51.
- 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. Am J Prev Med 2005;28(2):134–40.
- National Center for Safe Routes to School. Shifting modes: a comparative analysis of Safe Routes to School Program elements and travel mode outcome. In: U.S. Department of Transportation FHA, ed. saferoutesinfo.org: National Center for Safe Routes to School; 2012.
- 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(1):10.
- Lubans DR, Boreham CA, Kelly P, Foster C. 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):39.
- Stewart O, Moudon AV, Claybrooke C. Multistate evaluation of Safe Routes to School
Programs. Am J Health Promotion 2014;28(Suppl 3):S89–96.
- Zimmerman S, Lieberman M, Kramer K, Sadler B. At the intersection of active transportation and equity: Joining forces to make communities healthier and fairer. 2015.
Available at: At the Intersection of Active Transportation and Equityexternal icon. Accessed July 10, 2018.
- Larouche R, Saunders TJ, Faulkner GE, Colley R, Tremblay M. Associations between active school transport and physical activity, body composition, and cardiovascular fitness: a systematic review of 68 studies. Journal of Physical Activity and Health 2014;11(1).
- Watson M, Dannenberg AL. Investment in safe routes to school projects: public health benefits for the larger community. Prev Chronic Dis 2008;5(3):A90.
- DiMaggio C, Li G. Effectiveness of a safe routes to school program in preventing school-aged pedestrian injury. Pediatrics 2013;131(2):290–96.
- Ragland DR, Pande S, Bigham J, Cooper JF. Ten years later: Eexamining the long-term impact of the California Safe Routes to School program. 2014.
- Muennig PA, Epstein M, Li G, DiMaggio C. The cost-effectiveness of New York City’s Safe Routes to School program. Am J Public Health 2014;104(7):1294–9.
- Pedroso M. Investing in walking, biking, and safe routes to school: A win for the bottom line. 2017. Available at: Investing in Walking, Biking, and Safe Routes to School: A Win for the Bottom Lineexternal icon. Accessed July 10, 2018.