title: Active and safe transportation of elementary-school students: comparative analysis of the risks of injury associated with children travelling by car, walking and cycling between home and school.
abstract: BACKGROUND
  Elementary school active transportation programs aim to address physical inactivity in children by prompting a modal shift from travel by car to walking or cycling among children living a distance from school conducive to walking or cycling. The objectives of this study are to evaluate the risk of injury related to walking, cycling and travelling by car between home and school among elementary-school students in the Montréal area and to evaluate the impact on number of injuries of a modal shift from travel by car to walking or cycling.
  
  
  METHODS
  The risk of injury was estimated for the 2003-2007 period by calculating the average annual rate of injury in children aged 5 to 12 years walking, cycling or being driven in a car, per 100 million kms travelled during the normal hours of travel between home and school. The impact of a modal shift from travel by car was evaluated for children living a distance from school conducive to walking and cycling (under 1.6 km), that is, the targets of active transportation programs. This evaluation was done using the regional rate of injury calculated for each travel mode.
  
  
  RESULTS
  Between 2003 and 2007, an average of 168 children aged 5 to 12 years were injured each year while walking (n = 64), cycling (n = 28) and being driven in a car (n = 76) during the normal hours of travel between home and school in the Montréal area. The rate of injury was 69 children injured per 100 million kms for travel by car (reference group), 314 pedestrians (relative risk [RR] = 4.6; 95% confidence interval [CI]: 4.3-5.1) and 1519 cyclists (RR = 22.2; 95% CI: 14.3-30.0). A shift of 20% in the distance travelled by car to walking by children living less than 1.6 km from their school is estimated to result in an increase of 2.2% (n = 3.7) in the number of children injured each year in the area. In the case of a shift to cycling, the number of resulting injuries is estimated to be 24.4, an increase of 14.5%.
  
  
  CONCLUSIONS
  The risk of injury among elementary-school students during the normal hours of travel between home and school is higher for walking and cycling than for travel by car, and cyclists are at greater risk of injury than pedestrians. A modal shift from travel by car would increase the number of children injured in the area (minor injuries, for the most part) if no action were taken to reduce the risk of injury to pedestrians and cyclists.
authors.affiliation: Unité Sécurité et prévention des traumatismes, Direction du développement des individus et des communautés, Institut national de santé publique du Québec, Québec, Quebec, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Lavoie
authors.affiliation: Unité Sécurité et prévention des traumatismes, Direction du développement des individus et des communautés, Institut national de santé publique du Québec, Québec, Quebec, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Burigusa
authors.affiliation: Unité Sécurité et prévention des traumatismes, Direction du développement des individus et des communautés, Institut national de santé publique du Québec, Québec, Quebec, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Maurice
authors.affiliation: Direction de l'analyse et de l'évaluation des systèmes de soins et services, Institut national de santé publique du Québec, Québec, Quebec, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Hamel
authors.affiliation: Direction des études et des stratégies en sécurité routière, Société de l'assurance automobile du Québec, Québec, Quebec, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Turmel
mesh_terms: D001336:Automobiles / Q000706:statistics & numerical data*; D001642:Bicycling / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D006293:Health Promotion; D006801:Humans; D011792:Quebec / Q000453:epidemiology; D018570:Risk Assessment; D013334:Students / Q000706:statistics & numerical data*; D014186:Transportation / Q000379:methods / Q000706:statistics & numerical data*; D016138:Walking / Q000293:injuries*; D014947:Wounds and Injuries / Q000453:epidemiology*
keywords: active transportation; cyclists; elementary school; injury; pedestrians; risks; travel; trips