title: Association of the Safe Routes to School program with school-age pedestrian and bicyclist injury risk in Texas.
abstract: BACKGROUND
  Safe Routes to School (SRTS) is a federally funded transportation program for facilitating physically active commuting to and from school in children through improvements of the built environment, such as sidewalks, bicycle lanes, and safe crossings. Although it is evident that SRTS programs increase walking and bicycling in school-age children, their impact on pedestrian and bicyclist injury has not been adequately examined.
  
  
  METHODS
  We analyzed quarterly traffic crash data between January 2008 and June 2013 in Texas to assess the effect of the SRTS program implemented after 2009 on school-age pedestrian and bicyclist injuries.
  
  
  RESULTS
  The annualized rates of pedestrian and bicyclist injuries between pre- and post-SRTS periods declined 42.5% (95% confidence interval (CI) 39.6% to 45.4%) in children aged 5 to 19 years and 33.0% (95% CI 30.5% to 35.5%) in adults aged 30 to 64 years. Negative binomial modeling revealed that SRTS intervention was associated with a 14% reduction in the school-age pedestrian and bicyclist injury incidence rate ratio (IRR 0.86, 95% CI 0.75 to 0.98). The effect of the SRTS intervention on pedestrian and bicyclist fatalities was similar though smaller in magnitude and was not statistically significant (adjusted IRR 0.90, 95% CI 0.67 to 1.21).
  
  
  CONCLUSIONS
  These results indicate that the implementation of the SRTS program in Texas may have contributed to declines in school-age pedestrian and bicyclist injuries.
authors.affiliation: Department of Surgery, New York University School of Medicine, 550 First Avenue, New York, 10016, NY, USA. Charles.DiMaggio@nyumc.org.|Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168 Street, New York, 10032, NY, USA. Charles.DiMaggio@nyumc.org.
authors.forename: Charles
authors.initials: C
authors.lastname: DiMaggio
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168 Street, New York, 10032, NY, USA.
authors.forename: Joanne
authors.initials: J
authors.lastname: Brady
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168 Street, New York, 10032, NY, USA.|Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.|Center for Injury Epidemiology and Prevention, Columbia University, New York, NY, USA.
authors.forename: Guohua
authors.initials: G
authors.lastname: Li