1. Active Transport to School: A Call for More Physical Activity in Adolescents
Amanda Rose Tynan
Abstract
Adolescent obesity rates are climbing at an alarming rate. In addition, the
associated health risks, such as diabetes and high blood pressure, are following suit.
Serious changes to lifestyle choices are required to alleviate this phenomenon. Through
diet and physical activity we can prevent increasing rates as well as reduce current rates
of adolescent obesity. One of the easiest ways to target adolescent populations is through
Active Transport to School, or ATS. This includes walking or biking, over more
sedentary modes of transportation. Because of schools’ relatively constant presence in an
adolescent’s life, this is an easy and cost-effective way to incorporate physical activity
into their daily routine. That being said, there are a number of barriers that current policy
fails to address. These include: (1) demographic barriers such as gender, race, and
income, (2) individual barriers such as behaviors and perceptions, (3) physical barriers
such as inadequate infrastructure, and (4) institutional barriers such as academic and
governmental policies. This policy proposal addressed these barriers and other current
holes in policy as well as proposes changes at each level. Also included are the current
policies centered on this issue and case studies that illustrate the changes, and lack of
changes, that current policy institutes.
Current Policies
The current American Public Health Association policy surrounding this issue are listed
below:
(1) Improving Health Through Transportation and Land-Use Policies (2009, Policy
No. 20099)
(2) American Public Health Association Child Health Policy for the United States
(2010, Policy No. 201013)
(3) Supporting the National Physical Activity Plan (2012, Policy No. 20121)
(4) Physical Fitness as a Public Health Issue (1978, Policy No. 7835)
(5) APHA Resolution on Overweight in Childhood (2001, Policy No. 200113)
(6) Promoting Public Health Through Physical Activity (1997, Policy No. 9709)
(7) Encouraging Healthy Behavior by Adolescents (2000, Policy No. 200027)
(8) Health of School-Age Children (1979, Policy No. 7905)
(9) Building a Public Health Infrastructure for Physical Activity Promotion (2007,
Policy No. 20079)
Problem Statement
Childhood obesity in America is a phenomenon that is growing at an alarming
rate. In the past 30 years, childhood obesity has increased by over 50%. In 2012,
approximately one-third of our nation’s youth were considered overweight or obese
(Ogden, 2014). Obesity is defined as having and excess of body fat, whereas overweight
is defined as being heavier than the recommended weight for a particular height (National
Institutes of Health, 2010). Current literature argues that adolescence is a vulnerable

2. period in human development that makes this demographic particularly prone to
deleterious health outcomes associated with obesity and weight gain. This includes, but is
not limited to: sleep apnea, hypertension, type II diabetes, cardiovascular disease, and
high blood pressure (Daniels, 2005). Additionally, problems with self-esteem and
stigmatization as a function of obesity are more strongly associated with children than
adults (CDC, 2014).
The Center for Disease Control recommends instituting healthy lifestyle habits as
a preventative measure for both adults and adolescents. This includes healthy eating
behaviors and increased physical activity. It is also recommends that these preventative
measures are not limited to home life, but also may include, the institutional and
community levels (CDC, 2014). Ellis et al. (2005) points out the importance of school for
the adolescent age group in instituting lifestyle change. His research argues that when
schools, families and communities come together to encourage physical activity, healthy
diets, and restrictions on sedentary activities, the highest level of effectiveness is
achieved. One way to incorporate more physical activity is by partaking in active
transport to school via walking and biking to school. This problem statement aims to
address institutional and structural barriers, individual barriers, and potential
marginalized populations in regard to active transport to school, or ATS.
1. Demographic Barriers: Gender, Race, and Income
There are many factors that contribute to ATS including: gender, ethnicity,
income, type of school, type of community, and distance to school (Babey et al., 2009).
In particular, gender plays a key role in the amount of ATS utilized by individuals,
especially in older youths. In a study of 2, 692 junior and senior high students in Northern
Utah found that males were 2.69 times more likely to use ATS than females. Bungum et
al. (2008) says there is a need for more research on this gender disparity, but common
sentiments in females were centered on safety and hair maintenance.
In addition to gender, ethnicity plays a key role in all age groups for adolescents.
In a study by Babey et al. (2009), 3,451 adolescents responded to a Health Interview
Survey in Los Angeles. This study showed that Latino males whom attend public schools
that are a short distance from their low-income neighborhoods are the most likely to use
ATS, compared to other ethnicities. Additionally, adolescents without an adult present
after school and those whose parents don’t know much about their whereabouts after
school were more likely to use ATS.
A study by McDonald et al. (2008) showed the role income plays in ATS. His
findings showed that black, Hispanic, and lower-income students use ATS modes more
that white and higher-income students. This study harvested data from 14, 553 students
through out the United States in the hopes of documenting ATS rates in low-income
minority youth. A study by Zhu et al. (2008) showed that there is a statistically
significant correlation with parent’s education level and income to car ownership as well
as a negative correlation with ATS. Therefore, interestingly enough, adolescents from
higher income homes are less likely to chose ATS modes of travel.
2. Individual Barriers: Behaviors and Perceptions

3. Another factor that plays a role in deciding to practice ATS modes of travels
versus sedentary modes is behavior. A study done in 2009 by Deforche and Dyck found
that there was a strong correlation between physical activity, such as walking or biking,
and self-efficacy. In this study, 1448 children were randomly selected across 20 different
schools and asked to fill out a questionnaire. The sample was divided into children with
low self-efficacy (N=451) and high self-efficacy (N=932) toward physical activity.
Adolescents with lower self-efficacy had, on average, 43 few minutes of physical activity
a day. Additionally, they found their environment to be less supportive for physical
activity. For example, compared to adolescents with high self-efficacy, they reported
longer walking distances to neighborhood facilities and lower neighborhood bike-ability.
However, both groups were found to be the most strongly influenced by social support of
friends and family, regardless of their self-efficacy. This illustrates the fluidity of
individual barriers by fostering community and interpersonal support in the context of
physical activity.
Perceived safety is another behavioral barrier to ATS. A study by the CDC in
1999 found that the two greatest deterrents to walking and biking to school are (a) long
distances, and (b) dangerous motor vehicle traffic and the parental concern associated
with traffic. Zhu et al. (2008) also found that parental perceived safety was a strong
correlate to adolescent ATS rates. They found that, again, social influence was important
in alleviating these barriers. If large groups of adolescents walk to school together,
parents are more likely to allow them to do it.
Physical Barriers: The Essential Role of Infrastructure and Planning
An observational study done in New Orleans assessed changes in frequency and
use of bikes before and after the installation of bike lanes in a high traffic area. Observers
were put out on the street to count the number of cyclists at 2 points for a 10-day span.
The area of interest was diverse economically, ethnically, and was a mix-use region
(walking, biking, jogging, driving, etc.). As a result of bike lanes being painted, more
people were found to ride bikes – particularly for women. Increased perceived safety and
self-efficacy were noted as well. Additionally, more people chose to bike in the correct
direction (with traffic) and avoided side streets due to increased connectivity and safety
(Parker, 2013). Without bike lanes, pedestrians were unsure of bike laws, did not utilize
main roads, and opted out of biking for other modes of transportation.
In addition to bike lanes, distance to school can play an essential role in ATS. A
long-term survey done between the years of 1969 and 2001 show that there is little
temporal variation in the key role distance plays in the decision to walk or bike to school.
That being said, distance to school has increased over time and may account for some of
the decline in ATS. In 1969, 40.7% of students in the survey walked or biked to school,
whereas in 2001 only 12.9% did. The study done by Zhu et al. (2008) also found distance
to school as the primary driver in choosing ATS.
Institutional Barriers: Government and School
A study done in 2011, examined the impact of state laws related to sidewalks and
safe routes to school on elementary school-level policies and practices. They hoped it

4. determine whether elementary school policies and practices differed in states with these
laws as compared to states without these laws in terms of: (a) barriers to walking or
biking to school, (b) allowing walking or biking to school, and (c) the amount of students
walking or biking to school. The analyses took place between 2007 and 2009 and found
that state policies had a strong effect on resulting school policies. They found that schools
were less likely to report lack of sidewalks or lack of crossing guards as barriers to
walking/biking to school if the state law required them. Schools were less likely to report
traffic danger as a barrier if the state law required traffic control measures. State laws did
not directly control if kids were walking or biking to school but they did strongly
influence the policies that schools made. Providing the infrastructure to safely walk or
bike to school, lays the foundations for ATS (Chriqui et al, 2011), and there is a call for
more policies of this nature to take hold in schools across the nation.
Another study analyzed the positive effects of a school-level policy called Active
Day School policy in Boston, MA. The policy’s main objectives were to provide
equipment, materials, and training to physical educators in order to achieve a minimum
of 150 minutes per week of physical activity. 467 eligible students in the 4th
and 5th
grades were included in this study that took place between February and June of 2011. As
a result of this school-level policy, moderate and vigorous physical activity increased by
24%. The policy was a low-cost, easy-to-implement policy that received extremely
positive results (Cradock et al., 2014). Although, this is not specific to ATS, it illustrates
the influence of school and school-level changes on a population of adolescents.
Opposing Arguments
There is very little opposition to the idea that American youth obesity rates are
something to be concerned about. With the suite of associated health risks, many of
which have no historically been common in youth, it is undeniably a topic of concern in
this country. Obesity is an epidemic that is sweeping the nation without discrimination on
age or gender.
That being said, a two-year bill called MAP-21, passed in 2012, made dramatic
cuts to “alternative transportation” funding, which includes walking and biking programs.
In addition, this bill pulled funding from Safe Routes to School, which is a popular and
cheap program utilized by schools all over the nation. This made significant setbacks in
the development of programs such as Safe Routes to School (Safe Routes Partnership,
2012).
The primary form of opposition to ATS as one of many preventative measures
against childhood obesity is lack of funding. This may reflect the lack of perceived
benefits of active commute as well as the general lack of revenue from a policy of this
nature. A 2006 study done in Australia, analyzed why certain modes of transportation are
chosen over others and ways to encourage frequent ATS in adolescents. One of the
strongest positive correlations in this study was between perceived benefits of ATS and
frequency of ATS, showing that when information on health benefits associated with
ATS is available, frequency and preference of ATS increases.
Evidence Based Strategies

5. A number of policies are addressing the issue of childhood obesity, some of
which are focusing on the physical fitness aspect. Infrastructure that facilitates walking
and biking to school is heterogeneous throughout the country, but most places have the
tools to produce more. Additionally, most initiatives are targeting public health and are
aimed at the general population, only a few target specific populations such as families,
children, or neighborhoods, and even less target minority populations. Finally, the most
resounding hole in current policy is the lack of cohesion between the child, family,
school, and community stakeholders. Most policy addresses one or two of those
stakeholders and studies show that after the fact, there is always a desire for help at other
levels to reinforce the changes. Even when the policy is trying to drive behavioral
changes in adolescents, there is still a need for multi-level strategies at the individual,
family, school, and community level (Merom et al., 2006).
For adolescents, school is typically a constant presence until adulthood. Therefor,
policy that promotes increased levels of physical activity in school has the potential to
make great changes in their health. Because distance to school is one of the strongest
determinants for children using ATS, school sitting has emerged as a key issue. School
sitting determines the travel distance as well as the presence of highways or freeways
along the route. Current policies such as minimum school size and incentives for new
school construction may be pushing schools away from where children live, and thereby
deterring ATS (Zhu et al., 2008). This also reduces parental perceived safety and hinders
ATS for adolescents with lower self-efficacy. A study done by Cradock et al. in 2014
showed that in areas where crime rates or infrastructure are not conducive to ATS, there
are other impactful options for policy makers. The Boston Active School Day increased
students’ activity levels by 24% at a cost of only $14/student.
Finally, the perceived benefits of ATS and other nonfinancial benefits need to be
more apparent to the general public and policy makers. A study done in Houston, showed
where state funding is allocated and why more money is not put toward biking and
walking infrastructure. They found that other infrastructure projects score higher on the
project selection ranks and outcompete infrastructure funding for biking and walking.
This is because the nonfinancial benefits of biking and walking are not considered in the
selection process. There is a call for more available literature on these benefits in the
context of America’s growing obesity epidemic, as well as a public outreach campaign.
Action Steps
A number of changes to current policy would be beneficial to adolescent health
and wellbeing. These changes include lifting the racial, gender, and income disparities,
alleviating individual barriers through community, and removing physical barriers. These
changes can be cost-effective, minimally intrusive, and easy to implement. There is a
need for further large-scale prevention studies to expand the limited evidence base upon
which clinical recommendations and public health approaches can be formulated. This
must be coupled with increased monitoring and continued support from all stakeholders
at global, national, regional and local levels. Preventative interventions currently should
involve the child, family, school and community.
In order to change these cultural binaries, it may require policy to target certain
demographics to even the playing field. For example, targeting the female demographic

6. could alleviate the gender disparity. Through community outreach and education
programs, community members could focus on increasing the female ATS percentage.
These programs could include health and fitness education to identify some of the
benefits of ATS as well as female groups that use ATS to and from school to promote
social behavior and increase perceived safety. In addition, education and public outreach
campaigns can provide information to all income brackets and ethnicities in an area. By
providing information on the health benefits of ATS, all peoples will have the tools to
make healthy decisions, no matter their income or race.
With the installment of proper bike lanes and crossing areas, infrastructure can act
to alleviate some of the individual barriers associated with ATS. Proper infrastructure
facilitates confidence, increased perceived safety, and accessibility to less skilled bikers.
Also, when infrastructure provides straightforward guidelines on where bikers, walkers,
and cars are supposed to be, all travelers experience increased safety and confidence in
their mode of travel. In addition to the aforementioned public outreach and increased
information accessibility, policy makers and government officials can more readily use
that information in their policy decisions.
Also, as mentioned before, both institutional and governmental policy changes
can be quite influential, especially when the community and families back it up. As seen
in the Boston case study, with an institutional policy they saw dramatic improvements at
a cost that most demographics could afford. It is recommended that state and national
governments promote programs such as Safe Routes to School and allocate a set amount
of funding for SRTS and programs of the like. State laws affecting sidewalks and safe
routes to school are associated with school-level policies related to ATS. These laws need
to be considered in addition to SRTS funding and programming as a means for
facilitating ATS. Programs like this not only promote a certain culture around ATS, but
they allocate funds to the development of safety measures such as crossing guards and
reduced speeds in residential areas in the perimeter of school. Increased safety and
established routes to school will facilitate ATS for more students, which will create more
social groups create a positive feedback to increasing ATS.
In conclusion, future policies are required to address the adolescent obesity
epidemic at the individual, family, school, and community level. In order for changes to
take hold it must be done in a cohesive way, with special attention paid to the school
system. There is a call for more research on ways to implement preventative measures to
adolescent populations in the context of obesity and associated health risks. The science
is there and the best thing to do at this point is spread that information to as many people
as possible to promote healthy choices and creative ideas for our future. Until we can
strengthen this knowledge base, policy should be directed at promoting physical activity
through ATS and other school level programs, supported by local governments and
community members.
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