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Walking and child pedestrian injury: a systematic review of built environment correlates of safe walking
  1. Linda Rothman1,2,
  2. Ron Buliung3,
  3. Colin Macarthur1,4,5,
  4. Teresa To1,2,5,6,
  5. Andrew Howard1,5,7,8
  1. 1Department of Child Health Evaluative Science, The Hospital for Sick Children, Toronto, Ontario, Canada
  2. 2Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
  3. 3Department of Geography, University of Toronto, Mississauga, Ontario, Canada
  4. 4Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
  5. 5Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  6. 6Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  7. 7Division of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
  8. 8Department of Surgery, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Linda Rothman, Child Health Evaluative Science, Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada M5G 1X8; linda.rothman{at}


Background The child active transportation literature has focused on walking, with little attention to risk associated with increased traffic exposure. This paper reviews the literature related to built environment correlates of walking and pedestrian injury in children together, to broaden the current conceptualization of walkability to include injury prevention.

Methods Two independent searches were conducted focused on walking in children and child pedestrian injury within nine electronic databases until March, 2012. Studies were included which: 1) were quantitative 2) set in motorized countries 3) were either urban or suburban 4) investigated specific built environment risk factors 5) had outcomes of either walking in children and/or child pedestrian roadway collisions (ages 0-12). Built environment features were categorized according to those related to density, land use diversity or roadway design. Results were cross-tabulated to identify how built environment features associate with walking and injury.

Results Fifty walking and 35 child pedestrian injury studies were identified. Only traffic calming and presence of playgrounds/recreation areas were consistently associated with more walking and less pedestrian injury. Several built environment features were associated with more walking, but with increased injury. Many features had inconsistent results or had not been investigated for either outcome.

Conclusions The findings emphasise the importance of incorporating safety into the conversation about creating more walkable cities.

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