There is strong evidence that the Safe Routes to School Program improves social outcomes, particularly by increasing active transportation (walking, biking, or other forms of physically active travel to school), and sufficient evidence that the Safe Routes to School Program is associated with reduced pedestrian injury risk.
The findings below synthesize the results of the studies on the Safe Routes to School (SRTS) program across three domains of measurement:
Safe, reliable transportation to and from school is a critical yet under-addressed determinant of young people’s health in the United States. Nearly 55 million students attend elementary, middle, and high schools each weekday, yet fewer than 13% walk or bike to school, compared to almost 50% in 1969[1]. This decline in active school transport has coincided with a sharp increase in childhood obesity, rising from 4% to approximately 20% by 2020[2], and elevated risks related to traffic injuries, air pollution, and neighborhood safety.
Many students, particularly in low-income and underrepresented racial and ethnic communities, experience unsafe walking and biking conditions due to long-standing underinvestment in infrastructure[3]. These same neighborhoods also experience higher rates of asthma, obesity, and pedestrian injuries. As school transportation budgets shrink, especially in economically stressed areas, bus routes are often eliminated, forcing children to rely on private vehicles or navigate unsafe routes to and from school.
Inadequate access to safe active transportation options contributes to sedentary behavior, limits access to outdoor activity, and increases environmental pollution from car dependence. Fatal and non-fatal pedestrian crashes accounted for approximately $17.6 billion in economic costs based on 2019 dollars, while cyclist crashes accounted for approximately $5.6 billion in economic costs. These are cost increases of 27% and 16%, respectively, over pedestrian and cyclist crashes in 2010[4],[5]. Improving school commute options offers a dual opportunity to reduce health risks and increase daily physical activity, particularly in communities where safe mobility options are limited.
Evidence suggests investments in safe, active transportation to schools are associated with reductions in pedestrian injuries, increased rates of walking and biking to school, and improved support for broader goals related to health equity and environmental sustainability[6]. The benefits are multipronged and range from increased walking and cycling to school, to improved student safety, lower transportation costs for both families and school districts, reduced student absences, cleaner air, improved student wellbeing, and more[7],[8],[9]. Healthy People 2030[10] and Vision Zero Network[11] emphasize the importance of safe and equitable mobility for children, reinforcing the public value of investments in school travel safety.
The Safe Routes to School program[12] is a national initiative aimed at increasing safe, active transportation options for school-aged children. It combines infrastructure improvements such as sidewalks, crosswalks, and traffic calming with safety education, law enforcement partnerships, and behavioral incentives to promote walking and bicycling to school. The program was established in 2005 under the federal Safe, Accountable, Flexible, Efficient Transportation Equity Act[13] and has since been implemented by local governments, school districts, and community organizations.
Safe Routes to School interventions are not typically reimbursed through Medicaid or other healthcare funding streams.
Children in grades 3-5; 10 California elementary schools who passed by completed Safe Routes to School (SRTS) projects.
California SRTS construction projects, including sidewalks, traffic lights, and crosswalks.
Cost: Over $66 million.
Observational study with a comparison group. N = 862 usable observations from parents.
Social: Children who passed by completed SRTS projects were 11.1 percentage points more likely (15%; n=75/486) to show increases in walking or bicycle travel than children who did not pass by projects (4%; n=16/376; p<0.01). However, secondary outcomes of interest included reports that more parents stated their child walked or bicycled less (18%) after the SRTS project than those who reported their child walked or bicycled more (10.6%). Furthermore, 71.5% (n=616) of parents reported that their child’s activity level before and after construction was unchanged.
School aged pedestrians aged 5-19 in New York City between 2001 and 2010.
New York City SRTS engineering improvements (sidewalk extensions, speed bumps, pedestrian countdown signals, etc.) in 124 school areas.
Observational study with a comparison group.
Health: The annual rate of pedestrian injury decreased 33% (95% confidence interval [CI]: 30 to 36) among school-aged children (5- to 19-year-olds) and 14% (95% CI: 12 to 16) in other age groups. The annual rate of school-aged pedestrian injury during school-travel hours decreased 44% (95% CI: 17 to 65) from 8 injuries per 10,000 population in the preintervention period (2001-2008) to 4.4 injuries per 10,000 population in the postintervention period (2009-2010) in census tracts with SRTS interventions. The rate remained virtually unchanged in census tracts without SRTS interventions (0% [95% CI: -8 to 8]).
School aged pedestrians and bicyclists (aged 5-19), and adults 30-64 years in Texas between January 2007 and June 2013.
Safe Routes to School (SRTS), 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.
Pre-post analysis.
Health: 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% (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).
Students in the Chula Vista Elementary School District in San Diego (CVESD).
Safe Routes to School Program in CVESD, including initiatives to make it safe for students to walk and bike to school.
Pre-post study using parent survey data. 6,426 observations from parents were used. Data from 12,500 students from 19 schools between 2009 and 2019 were used, from the tally survey tracking student travel behavior.
Social: Participants had 1.27 times higher odds of walking home from school in the evening during the program compared to before or after.
Distance was the most influential predictor—walking was highest among students living < ¼ mile from school.
Chi-square tests showed a significant association between walking and the program period, with walk percentages increasing in the evening when children were going home (p = 0.037 morning; p < 0.001 evening).
The likelihood of walking increased during SRTS and in some cases declined afterward.
Elementary and middle school students (grades K–8) across 801 schools in the District of Columbia, Florida, Oregon, and Texas between 2007 and 2012.
Safe Routes to School (SRTS) infrastructure projects including sidewalk improvements, crosswalks, traffic calming, signage, and bicycle/pedestrian facilities.
Observational study with a comparison group. N = 65,000 students and 16,000 parents from 801 schools across three states and the District of Columbia.
Social: There was an absolute increase of 5.5 percentage points or a relative change of 31% in the proportion of students walking and bicycling to school after five years of participating in a SRTS program.
Walking and bicycling rose by 1.1 percentage points (p = .002) with each year of participation in the SRTS program, suggesting a dose-response relationship.
The presence of an engineering improvement was associated with a 3.3 percentage point increase in walking and bicycling (p = .031).
Education and encouragement interventions also had significant positive impacts on walking and bicycling, with each year of participation in an education and encouragement program associated with a 0.9 percentage point increase in walking and bicycling (p = .025).
Children exposed to SRTS roadway infrastructure improvements in New York City.
SRTS infrastructure improvements including traffic safety modifications (e.g., sidewalk extensions, pedestrian islands, speed humps, and countdown timers).
Cost-effectiveness analysis including societal costs (in 2013 U.S. dollars) and observed spatiotemporal changes in injury rates associated with New York City's implementation of SRTS relative to control intersections.
Healthcare Cost, Utilization & Value: SRTS was associated with an overall net economic and societal benefit of $230 million and an additional 2,055 quality-adjusted life years.
Elementary and middle school students in California.
California SRTS infrastructure countermeasures including sidewalks, crosswalks, and traffic calming measures near schools.
Pre-post study. N = 9 schools (active travel outcomes); N = 47 schools (injury outcomes).
Health: For collisions involving pedestrians/bicyclists ages 5 to 18, an incident rate ratio (IRR) of 0.47 was found, corresponding roughly to a 50% reduction in collisions in the treatment area (within 250 feet of the countermeasure) in relation to the area outside the treatment area. However, the effect did not reach the statistically significant level of 0.05.
For collisions involving pedestrians/bicyclists of all ages, the IRR was 0.26, corresponding to a collision reduction of about 75%, and was statistically significant.
Social: Living within 250 feet of a countermeasure increased the probability that a child walked to school (coefficient = 0.82; Z = 2).
Parents of children in grades 3-8 attending one of 35 Arizona schools that had implemented SRTS between 2007 and 2018.
Built environment features (e.g., distance from home to school, perceived support for active travel, school income level, parental perceptions).
Descriptive study. N = 2,751 parents.
Social: The likelihood of active school travel (AST) decreased as intersection density and distance increased (i.e., 31.0% reduced odds among those living within ¼ mile compared to 18.2% using ½–1-mile criterion). The likelihood of using AST were reduced as food-related land use and distance increased (i.e., 43.67% reduced odds among those living under ¼ mile compared to 19.83% reduced odds among those living ½–1 mile).
Students in 53 schools affected by 48 completed SRTS projects across four U.S. states (Florida, Mississippi, Washington, Wisconsin).
State Safe Routes to School (SRTS) programs providing competitive grants to local projects that support safe walking, bicycling, and other modes of active school travel (AST).
Pre–post analysis. Data were analyzed separately at the project (n = 48) and school (n = 53) levels.
Social: Statistically significant increases were observed across projects in all four states; all AST modes combined increased from 12.9% to 17.6% (walking from 9.8% to 14.2% and bicycling from 2.5% to 3%).
School aged children in El Paso County, Texas.
Safe Routes to School (SRTS) policies.
Agent-based modeling. 10,000 school-aged children were simulated under two scenarios—SRTS policies implemented and no SRTS policies implemented.
Healthcare Cost, Utilization & Value: When SRTS policies were implemented, the model estimated reduced cardiovascular disease-related healthcare costs ($13,788/person).
Health: When SRTS policies were implemented, the model estimated 157 fewer coronary heart disease cases and 217 fewer stroke cases per 10,000 people.
Children in settings with Safe Routes to School interventions.
Safe Routes to School interventions.
A rapid realist review. 45 studies were included in the analysis.
The analysis determined SRTS interventions are effective at motivating children to choose active school travel (AST), but ultimately engagement is determined by parental decision-making.
[1] Stankov I, Garcia LM, Mascolli MA, Montes F, Meisel JD, Gouveia N, Sarmiento OL, Rodriguez DA, Hammond RA, Caiaffa WT, Roux AV. A systematic review of empirical and simulation studies evaluating the health impact of transportation interventions. Environmental research. 2020 Jul 1;186:109519.
[2] Centers for Disease Control and Prevention. Childhood Obesity Facts. Atlanta (GA): Centers for Disease Control and Prevention. 2024 Apr 1. Available from: https://www.cdc.gov/obesity/childhood-obesity-facts/childhood-obesity-facts.html
[3] Safe Routes Partnership. Equity in Safe Routes to School. Safe Routes Partnership. Available from: https://www.saferoutespartnership.org/safe-routes-school/101/equity
[4] Swedler DI, Ali B, Hoffman R, Leonardo J, Romano E, Miller TR. Injury and fatality risks for child pedestrians and cyclists on public roads. Injury epidemiology. 2024 Apr 11;11(1):15.
[5] Blincoe L, Miller T, Wang J-S, Swedler D, Coughlin T, Lawrence B, et al. The economic and societal impact of motor vehicle crashes, 2019 (Revised). Report No.: DOT HS 813 403. National Highway Traffic Safety Administration; 2023 Feb.
[6] Centers for Disease Control and Prevention. Safe Routes to School: Policies and Strategies. CDC. Available from: https://archive.cdc.gov/www_cdc_gov/policy/hi5/saferoutes/index.html
[7] Attendance Works. The 100 Mile Club: Building Healthy Attendance. Attendance Works. 2015 May. Available at: https://www.attendanceworks.org/the-100-mile-club-building-healthy-attendance/
[8] Safe Routes Partnerships. Safe Routes to School. Safe Routes Partnerships. Available at: https://www.saferoutespartnership.org/safe-routes-school/101/benefits
[9] Castelli DM, Glowacki EM, Barcelona JM, Calvert HG, Hwang J. Active Education: Growing Evidence on Physical Activity and Academic Performance. Research Brief. Active Living Research; 2015 Jan.
[10] Office of Disease Prevention and Health Promotion. Healthy People 2030. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Available from: https://odphp.health.gov/healthypeople
[11] Vision Zero Network. Vision Zero Highlights. Vision Zero Network. Available from: https://visionzeronetwork.org/
[12] National Highway Traffic Safety Administration. Other strategies for behavior change. U.S. Department of Transportation, NHTSA. Available from: https://www.nhtsa.gov/book/countermeasures-that-work/bicycle-safety/countermeasures/other-strategies-behavior-change/safe
[13] U.S. Department of Transportation. Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users (SAFETEA‑LU). U.S. Dept of Transportation; 2015. Available from: https://www.transportation.gov/civil-rights/disadvantaged-business-enterprise/safetea-lu-act
