Organisational travel plans for improving health.
BACKGROUND
Dependence on car use has a number of broad health implications, including contributing to physical inactivity, road traffic injury, air pollution and social severance, as well as entrenching lifestyles that require environmentally unsustainable energy use. Travel plans are interventions that aim to reduce single-occupant car use and increase the use of alternatives such as walking, cycling and public transport, with a variety of behavioural and structural components. This review focuses on organisational travel plans for schools, tertiary institutes and workplaces. These plans are closely aligned in their aims and intervention design, having emerged from a shared theoretical base.


OBJECTIVE
To assess the effects of organisational travel plans on health, either directly measured, or through changes in travel mode.


METHODS
We searched the following electronic databases; Transport (1988 to June 2008), MEDLINE (1950 to June 2008), EMBASE (1947 to June 2008), CINAHL (1982 to June 2008), ERIC (1966 to June 2008), PSYCINFO (1806 to June 2008), Sociological Abstracts (1952 to June 2008), BUILD (1989 to 2002), Social Sciences Citation Index (1900 to June 2008), Science Citation Index (1900 to June 2008), Arts & Humanities Index (1975 to June 2008), Cochrane Database of Systematic Reviews (to August 2008), CENTRAL (to August 2008), Cochrane Injuries Group Register (to December 2009), C2-RIPE (to July 2008), C2-SPECTR (to July 2008), ProQuest Dissertations & Theses (1861 to June 2008). We also searched the reference lists of relevant articles, conference proceedings and Internet sources. We did not restrict the search by date, language or publication status.


METHODS
We included randomised controlled trials and controlled before-after studies of travel behaviour change programmes conducted in an organisational setting, where the measured outcome was change in travel mode or health. Both positive and negative health effects were included.


METHODS
Two authors independently assessed eligibility, assessed trial quality and extracted data.


RESULTS
Seventeen studies were included. Ten were conducted in a school setting, two in universities, and five in workplaces. One study directly measured health outcomes, and all included studies measured travel outcomes. Two cluster randomised controlled trials in the school setting showed either no change in travel mode or mixed results. A randomised controlled trial in the workplace setting, conducted in a pre-selected group who were already contemplating or preparing for active travel, found improved health-related quality of life on some sub scales, and increased walking. Two controlled before-after studies found that school travel interventions increased walking. Other studies were judged to be at high risk of bias. No included studies were conducted in low- or middle-income countries, and no studies measured the social distribution of effects or adverse effects, such as injury.


CONCLUSIONS
There is insufficient evidence to determine whether organisational travel plans are effective for improving health or changing travel mode. Organisational travel plans should be considered as complex health promotion interventions, with considerable potential to influence community health outcomes depending on the environmental context in which they are introduced. Given the current lack of evidence, organisational travel plans should be implemented in the context of robustly-designed research studies, such as well-designed cluster randomised trials.
Hosking
Jamie
J
School of Population Health, University of Auckland, Private Bag 92019, Auckland, New Zealand.
Macmillan
Alexandra
A
Connor
Jennie
J
Bullen
Chris
C
Ameratunga
Shanthi
S
D000328:Adult; D001334:Automobile Driving; D001642:Bicycling; D002648:Child; D015444:Exercise; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D009936:Organizational Innovation; D016032:Randomized Controlled Trials as Topic; D012574:Schools; D014195:Travel; D016138:Walking; D017132:Workplace