Child Pedestrian-Motor Vehicle Collisions and Walking to School in the City of Toronto: The Role of the Built Environment

Introduction: Child pedestrian-motor vehicle collisions are a major population health issue worldwide. Although there are numerous benefits of active transportation, walking to school could potentially increase collision risk. The built environment has been associated with self-reported walking to school and with child pedestrian motor-vehicle collisions. It is important to determine if there are built environment features related to more walking but which also create safe walking environments. The thesis objective was to examine the relationships between observed walking to school, child pedestrian-motor vehicle collisions and the role of the built environment in Toronto, Canada.;Methods: Literature related to children walking for transportation, pedestrian-motor vehicle collisions and the built environment was systematically reviewed. Observational counts of school travel mode were conducted at 118 elementary schools in 2011 and mapped onto school attendance boundaries together with police-reported child pedestrian-motor vehicle collisions (2002-2011) and built and social environment data. The relationship between walking proportions and collision rates was examined controlling for the environment.;Results: There was a mean collision rate of 7.1/10,000/year within school boundaries. The mean proportion of observed walking was 67%. Several built environment features were related to more walking; however, school crossing guards reduced the influence of other features on walking. Walking to school was unrelated to collision rates once built environment features were controlled for. Higher multi-family dwelling density was related to lower collision rates; whereas higher one way street and traffic calming densities, lower traffic light density, school crossing guards and lower school socioeconomic status were related to higher collision rates. Significant features were generally related to road crossing.;Conclusions: This is the first large observational study examining walking to school, collision risk and the environment. Results suggest that safety is concerned with built environment features primarily related to road crossing, and not the numbers walking. The associations between school crossing guards and traffic calming with higher collision rates were unexpected. Mechanisms for mitigating road crossings for children are not well understood and controlled research designs are needed. Future policy to increase children's active transportation should be developed from strong evidence that addresses child pedestrian safety.