Organisational travel plans for improving health

Jamie Hosking; Alexandra Macmillan; Jennie Connor; Chris Bullen; Shanthi Ameratunga

doi:10.1002/14651858.CD005575.pub3

. 2010 Mar 17;2010(3):CD005575. doi: 10.1002/14651858.CD005575.pub3

Organisational travel plans for improving health

Jamie Hosking ¹, Alexandra Macmillan ^1,^✉, Jennie Connor ², Chris Bullen ³, Shanthi Ameratunga ¹

Editor: Cochrane Injuries Group

PMCID: PMC7387238 PMID: 20238341

Abstract

Background

Dependence on car use has a number of broad health implications, including contributing to physical inactivity, road traffic injury, air pollution and social severance, as well as entrenching lifestyles that require environmentally unsustainable energy use. Travel plans are interventions that aim to reduce single‐occupant car use and increase the use of alternatives such as walking, cycling and public transport, with a variety of behavioural and structural components. This review focuses on organisational travel plans for schools, tertiary institutes and workplaces. These plans are closely aligned in their aims and intervention design, having emerged from a shared theoretical base.

Objectives

To assess the effects of organisational travel plans on health, either directly measured, or through changes in travel mode.

Search methods

We searched the following electronic databases; Transport (1988 to June 2008), MEDLINE (1950 to June 2008), EMBASE (1947 to June 2008), CINAHL (1982 to June 2008), ERIC (1966 to June 2008), PSYCINFO (1806 to June 2008), Sociological Abstracts (1952 to June 2008), BUILD (1989 to 2002), Social Sciences Citation Index (1900 to June 2008), Science Citation Index (1900 to June 2008), Arts & Humanities Index (1975 to June 2008), Cochrane Database of Systematic Reviews (to August 2008), CENTRAL (to August 2008), Cochrane Injuries Group Register (to December 2009), C2‐RIPE (to July 2008), C2‐SPECTR (to July 2008), ProQuest Dissertations & Theses (1861 to June 2008). We also searched the reference lists of relevant articles, conference proceedings and Internet sources. We did not restrict the search by date, language or publication status.

Selection criteria

We included randomised controlled trials and controlled before‐after studies of travel behaviour change programmes conducted in an organisational setting, where the measured outcome was change in travel mode or health. Both positive and negative health effects were included.

Data collection and analysis

Two authors independently assessed eligibility, assessed trial quality and extracted data.

Main results

Seventeen studies were included. Ten were conducted in a school setting, two in universities, and five in workplaces. One study directly measured health outcomes, and all included studies measured travel outcomes. Two cluster randomised controlled trials in the school setting showed either no change in travel mode or mixed results. A randomised controlled trial in the workplace setting, conducted in a pre‐selected group who were already contemplating or preparing for active travel, found improved health‐related quality of life on some sub scales, and increased walking. Two controlled before‐after studies found that school travel interventions increased walking. Other studies were judged to be at high risk of bias. No included studies were conducted in low‐ or middle‐income countries, and no studies measured the social distribution of effects or adverse effects, such as injury.

Authors' conclusions

There is insufficient evidence to determine whether organisational travel plans are effective for improving health or changing travel mode. Organisational travel plans should be considered as complex health promotion interventions, with considerable potential to influence community health outcomes depending on the environmental context in which they are introduced. Given the current lack of evidence, organisational travel plans should be implemented in the context of robustly‐designed research studies, such as well‐designed cluster randomised trials.

Plain language summary

Travel plans in organisations (schools, tertiary education institutions and workplaces) for improving health

Travel plans aim to reduce car use and promote more active and sustainable travel such as walking and cycling. This review focuses on travel plans for organisations, such as workplaces or schools. The main reasons for using travel plans are to reduce congestion and to be environmentally friendly, but travel plans are also commonly claimed to improve health. We included 17 studies in this review. One study found that promoting walking in a workplace improved some aspects of health, including mental health, but no other studies directly measured health effects. All 17 studies looked at changes in travel. Although some found that travel plans increased walking, others did not. Overall, there is not enough evidence to know whether travel plans are effective at changing the way people travel, or whether they improve health. Currently, organisational travel plans should be put in place as part of well‐designed research studies.

Background

Description of the condition

The pattern of urban development over the past century has created a physical and social environment where dependence on car use has become the norm for accessing essential goods and services, as well as recreational opportunities. This condition has a number of broad health implications, including contributing to sedentary lifestyles, road traffic injury, air pollution and social severance, as well as entrenching lifestyles that require environmentally unsustainable energy use. The significant contribution of car‐dependent transport systems to climate change (IPCC 2007) is one manifestation of the public health implications of this unsustainable energy use. In addition, it is likely that the health effects of our current transport choices are inequitably distributed across socioeconomic strata, and by ethnicity (Roberts 1996, Frank 2004, Pearce 2008).

Description of the intervention

The term 'travel plan' refers to behaviour change programmes that aim to reduce single‐occupant car use, and increase the use of alternatives such as walking, cycling and public transport, through a variety of behavioural and structural interventions (Cairns 2004). Their implementation is most often encouraged by local and regional government to reduce traffic congestion. Although travel plans are not health interventions, they could potentially have health impacts in a number of different areas. For example, travel plans might increase physical activity, and physical activity is associated with a wide range of health benefits (US DoH 1996).

Travel plans aim to reduce car traffic. Reductions in car traffic would lead to a decline in air and noise pollution, which are associated with morbidity and mortality. Traffic may also have effects on mental health, social networks and child development (Dora 2000).

There may also be health risks associated with travel plans, depending on their implementation. A potential adverse effect of organisational travel plans that is of particular concern is the possibility of increasing road traffic injury to cyclists and pedestrians (due to increased exposure). There is also controversy about the differential exposure to air pollution for car occupants and pedestrians or cyclists, with some studies finding lower exposure to pedestrians and cyclists (for example Van Wijnen 1995) and other evidence suggesting that greater exposure to harmful pollutants occurs to pedestrians and cyclists (for example the Leicester case study in WHO HEARTS 2006). The impact on people with disabilities is also unclear. Travel plans and related interventions could potentially increase health inequalities, particularly if the success of their implementation depends on the ethnicity and socioeconomic status of the participating population (Collins 2005).

The risk of assault or abduction during travel is also an important influence on parents' decisions about travel to school (Rowland 2003). While the actual risk of such events may be low, the high perceived risk is a barrier to active transport for some. This may be addressed for children through adult‐supervised walking such as in the example of walking school buses (groups of children walking to school chaperoned by a number of volunteer parents).

Travel plans can only exert their health effects (and contribute to their congestion and environmental aims) if they are successful in changing travel behaviour. The health effects of travel plans are often viewed by design as "co‐benefits" rather than primary goals. It is important that the health impacts are well understood so that health benefits can be maximised, and health risks mitigated.

How the intervention might work

Travel plans exert their health effects by changing transport behaviour. Several types of travel plan have been described, including school, business and community travel plans (EECA 2005). This review will focus on school and business travel plans, as 'organisational' travel plans. These two types of plan have particular similarities: as both schools and businesses are organisations, the unit under study is similar. Travel occurs at similar times for both of these travel plan types; both types of plan focus on active transport (rather than leisure‐time physical activity); and schools could be considered the equivalent of 'workplaces' for children. They differ in that school children are less likely to be making their own choices about mode of travel.

Organisational travel plans comprise multiple components, the mix of which depends on the organisation in which they are implemented. Common components include:

organisational policies facilitating active transport (e.g. provision of cycle racks, lockers and showers) or restricting car transport (e.g. parking restrictions);
provision or co‐ordination of more active and sustainable transport options (e.g. walking bus or motorised school bus provision, public transport subsidies, carpooling co‐ordination);
engineering measures (e.g. pedestrian crossings, cycle ways, footpath improvements);
promotional measures for alternative transport (e.g. 'walk to school' days, promotion of alternatives to car use);
education measures (e.g. pedestrian safety or cycle training, education about benefits of active transport);
enforcement measures (e.g. speed restrictions);
travel demand reduction or spreading measures (e.g. telecommuting, flexible start/finish hours ‐ primarily for workplace travel plans);
other specific measures devised by the organisation in question.

In summary, organisational travel plans are complex interventions that aim to change how people travel, using a mix of different strategies, depending on the organisation in question. By changing how people travel, the plans may indirectly affect health. Health effects may occur because travel by different modes involves different risks and benefits, such as different levels of physical activity and injury risk.

Why it is important to do this review

If travel plans can be shown to have health benefits, they might in future be implemented as health promotion programmes. However, at present it is not clear whether travel plans affect health at all and, if so, whether they have a positive or negative effect. Despite this, community resources are starting to be allocated to develop and implement various plans, with benefits to health beginning to be seen as part of their rationale.

A systematic review is therefore required to assess the current evidence about the health effects of travel plans. The authors of this review are unaware of any pre‐existing review of travel plans and health. Related reviews have, however, been conducted, including a systematic review of broader interventions to promote walking and cycling (Ogilvie 2004). This review included some travel plans, but did not focus on travel plans as an intervention. Other related reviews have covered environmental and policy interventions to promote physical activity (Sallis 1998) and transport interventions for the improvement of population health (Morrison 2003). There have also been reviews of physical activity interventions in schools (Stone 1998) and workplaces (Dishman 1998), and a general review of physical activity interventions (Kahn 2002), but these have focused on non‐travel‐related physical activity. A systematic review of traffic calming (Bunn 2005) included interventions to improve road safety rather than travel behaviour change interventions. This review aims specifically to assess the effects of organisational travel plans on health.

Objectives

To assess the effects of organisational travel plans on health.

Methods

Criteria for considering studies for this review

Types of studies

Randomised controlled trials and controlled before‐after studies.

Types of participants

These interventions are conducted in organisations. Participants are therefore working age adults, tertiary students or schoolchildren. However, health effects may occur in people not participating in the intervention. For instance, an organisational travel plan may decrease traffic volumes in the local area. This could reduce respiratory disease due to air pollution, or reduce road traffic injuries. These effects would not be limited to participants in the intervention, and would occur across the local geographical area. Organisational travel plans may also have effects on the families of intervention participants (for instance, changing the transport choices of school children may also change the behaviour of their parents or siblings).

Accordingly, a study that aims to assess the health effects of organisational travel plans may define its participant population as being different from the population undertaking the intervention. Instead, the population in which outcomes are measured could potentially be defined as the entire local community.

Types of interventions

Organisational travel plans.

To be included, interventions must have been conducted in an organisational setting. This includes schools and workplaces, but not households or communities.

To be included, the intervention being studied must have been a travel behaviour change programme (Maunsell 2004). The programme must have aimed to change travel behaviour from relatively inactive transport to more active transport (e.g. from car use to walking or public transport use), or to change travel behaviour in a way that aims to reduce car use (e.g. carpooling). Thus, an intervention that aimed to increase walking for transport would be included, but walking itself as an intervention would not be included, since walking does not constitute a travel behaviour change programme.

Stand‐alone interventions that primarily aimed to improve road safety (such as traffic calming) were not considered to constitute travel behaviour change programmes. However, a travel behaviour change programme that included a traffic calming component would be eligible if conducted in an organisational setting.

Types of outcome measures

Primary outcomes

We considered any health outcomes relevant. These health outcomes could include, but were not limited to, obesity, cardiovascular disease and its risk factors, mental health and respiratory illness. Injury rates were of particular interest as a possible unintended negative consequence of organisational travel plans.

Secondary outcomes

Physical activity was a secondary outcome, since there is a large body of evidence linking physical activity levels to health outcomes.

Changes in travel mode (such as changes in the relative proportions of those travelling by car and those travelling by walking) was also a secondary outcome. There is a growing body of research linking travel mode to health outcomes, and relevant studies were likely to have measured travel mode shift as an outcome without directly measuring health outcomes. Health outcomes resulting from significant travel mode change could potentially be modelled from existing evidence.

We also considered the distribution of any relevant health effects, so that if organisational travel plans were shown to have effects on health inequalities, this was considered a relevant outcome.

Search methods for identification of studies

We did not restrict the search by date, language or publication status.

Electronic searches

We searched the following electronic databases:

Transport (1988 to June 2008),
MEDLINE (1950 to June 2008),
EMBASE (1947 to June 2008),
CINAHL (1982 to June 2008),
ERIC (1966 to June 2008),
PSYCINFO (1806 to June 2008),
Sociological Abstracts (1952 to June 2008),
BUILD (1989 to 2002),
Social Sciences Citation Index (1900 to June 2008),
Science Citation Index (1900 to June 2008),
Arts & Humanities Index (1975 to June 2008),
Cochrane Database of Systematic Reviews (to August 2008),
CENTRAL (to August 2008),
Cochrane Injuries Group Register (to December 2009)
Campbell Collaboration databases (C2‐SPECTR and C2‐RIPE, to July 2008),
ProQuest Dissertations & Theses (formerly known as Digital Dissertations, 1861 to June 2008)

All searches were last updated in June ‐ August 2008.

All search strategies are reported in full in Appendix 1.

Searching other resources

We searched:

The reference lists of relevant articles and books.
Further 'grey' literature, including relevant conference proceedings and Internet sources.

A list of web sites searched is provided in Appendix 2.

We originally planned to handsearch the journal Transportation Research (parts A‐F) from 1985 onwards (as stated in the review protocol). However, this journal is indexed by the Science Citation Index, which we searched, so we decided not to handsearch this journal.

Data collection and analysis

Selection of studies

Two authors independently assessed for inclusion all titles and/or abstracts identified from the literature search. Where, judging from the title and/or abstract, it was clear that a paper did not satisfy the eligibility criteria, we excluded it at that stage.

Where papers appeared to satisfy the eligibility criteria, or where it was not clear from the title and/or abstract whether or not the paper satisfied the eligibility criteria, we retrieved the full text of the paper and used it to further assess the paper for inclusion.

In the case of a discrepancy between the two authors' included papers, we resolved differences by discussion. If the two authors were unable to agree, a third author would arbitrate.

Data extraction and management

We designed a standard data extraction form. Two authors independently extracted data and entered it on to this form. Where discrepancies occurred between the two sets of data, we resolved differences by discussion. If the two authors were unable to agree, a third author would arbitrate. Where data were not available in the published study report, we contacted the authors of the study to request the required data.

Assessment of risk of bias in included studies

For all randomised studies that satisfied the eligibility criteria, we assessed the study quality on the basis of allocation concealment, blinding of outcome assessment, and loss to follow‐up.

There are fewer standardised approaches to quality assessment for controlled before‐after studies compared with randomised controlled trials. The exact criteria for appraising controlled before‐after studies was defined on the basis of the identified studies. However, in our protocol we planned to use an approach used in a previous Cochrane review (Bunn 2005) as a starting point, where the authors evaluated:   1. the length of data collection before and after the intervention;   2. how the intervention and control areas were matched;   3. the proximity of the control area to the intervention area.

On reviewing the identified studies, it became clear that of these three criteria, the first was not well‐suited to assessing organisational travel plans. The length of data collection before and after the traffic calming intervention was important in Bunn 2005 because they were counting relatively infrequent stochastic injury events, whereas studies included in our review were typically measuring changes in travel behaviour, a continuous outcome. The second and third criteria were combined into an criterion of 'Adequate matching of intervention/control areas?', which included matching by geographical location, baseline travel mode and relevant demographic characteristics.

Two authors independently appraised study quality. Where there was a discrepancy between authors in the appraised study quality, we resolved differences by discussion. If the two authors were unable to agree, a third author would arbitrate.

Data synthesis

We undertook a narrative synthesis of the data, and we tabulated key results.

We anticipated that the possibility for meta‐analysis of results was highly unlikely, due to the multiple different potential outcomes, interventions and participant characteristics under consideration. However, it is possible that even if meta‐analysis is not currently appropriate, it could be so in the future.

Thus, if meta‐analysis became possible, we would plan to use the following methods:

We would express summarised dichotomous data using relative risk (RR). We would express summarised continuous data using weighted mean difference (WMD) and/or standardised mean difference (SMD).
We would assess heterogeneity using chi‐squared and I² statistics. We have not planned to undertake sensitivity analyses. If heterogeneity existed, and we found sufficient studies, we would perform subgroup analysis comparing the following subgroups:

1. studies investigating school travel plans compared with studies investigating workplace travel plans;
2. randomised controlled trials compared with controlled before‐after studies.

We would assess publication bias using funnel plots.

Results

Description of studies

See Characteristics of included studies; Characteristics of excluded studies; Summary of intervention effects on car use and other travel mode outcomes.

Results of the search

Searches of electronic databases identified 9031 citations.

Additional references and links were also identified from web site searches.

From reviewing titles and abstracts, 83 citations were considered potentially relevant and full papers were retrieved for each of these. We excluded one conference abstract (Stahlspets 2006) because we were unable to contact the author and were thus unable to confirm the eligibility of the study.

Two projects that were identified from Internet searches (the Cambridgeshire Travel Choice Project (Sargeant 2004 Addenbrooke) and the Travelling to School Initiative (DfT 2005)) contained multiple arms or sub‐studies. Where the arms or sub‐studies have been included, these were considered as separate studies. The Travelling to School Initiative contained 10 sub‐studies, four of which met the inclusion criteria. The Cambridgeshire Travel Choice Project contained three arms, all of which met the inclusion criteria, and were treated as separate studies.

A total of 17 studies met the inclusion criteria.

Included studies

Design

Four randomised controlled trials were included. Of these, three were arms of the Cambridgeshire Travel Choice Project (Sargeant 2004 Addenbrooke), and one of these arms included both random and non‐random allocation components. Two cluster randomised trials were included (Rowland 2003, Wen 2008). The remaining eleven studies were controlled before‐after studies, four of which were sub‐studies of the UK Travelling to School Initiative (DfT 2005).

Settings

Twelve studies were conducted in an educational setting. Eight of these were set in primary/elementary schools only (approximate age range 5‐11) (Rowland 2003, TAPESTRY Dublin 2003, TAPESTRY Herts 2003, DfT 2005 Bracknell Forest, DfT 2005 Telford Wrekin, McKee 2007, Wen 2008, Mendoza 2009), and two more included both primary and secondary/high schools (approximate age ranges 5‐11 and 12‐18) DfT 2005 Lancashire, DfT 2005 Redcar Cleveland). Two studies were conducted in a tertiary education setting (Jacobs 1982, Nakayama 2005).

The remaining five studies were conducted in a workplace setting (Atherton 1982, Mutrie 2002, Sargeant 2004 Addenbrooke, Sargeant 2004 Car Park, Sargeant 2004 New Recruit).

Eleven of the 17 studies were conducted in the United Kingdom. There were three studies conducted in the USA (Atherton 1982, Jacobs 1982, Mendoza 2009), and one each from Japan (Nakayama 2005), Ireland (TAPESTRY Dublin 2003) and Australia (Wen 2008). No studies were conducted in low‐ or middle‐income countries.

Twelve studies were conducted solely in urban settings. However, all the arms of the UK Travelling to school initiative (four included studies) included rural primary schools and one further study was set only in rural primary schools (McKee 2007).

Participants

Participants were school children, university students or employees in workplaces, depending on the setting. Where reported, participants included both genders.

The participating schools in Mendoza 2009 were socioeconomically disadvantaged, with a high proportion of African American and Latino children. However, the distribution of outcomes between socioeconomic or ethnic groups was not reported.

No studies evaluated intervention effects on the wider community (for example, community road traffic injury rates).

Interventions

While all studies included interventions that aimed to change travel behaviour, not all were labelled 'travel plans'. Travel plan interventions were heterogeneous in their components, duration and intensity, reflecting the natural variability of such context‐dependent interventions.

Ten studies were conducted in the school setting. These interventions included multiple components targeting the school, individual schoolchildren and in some cases other bodies such as local councils. Intervention components varied across studies, but included the time of a travel coordinator; activities through local councils to improve the safety of the neighbourhood; provision of safety and promotional information to encourage car‐alternative modes of transport to school; within classroom educational modules; and the organisation of walking school buses (groups of children walking to school chaperoned by a number of volunteer parents). Some interventions were much more intensive than others, with substantial variation in the number of activities included in the intervention, the number of different groups targeted by the intervention (e.g. school, schoolchildren, councils) and the duration of the intervention. In Mendoza 2009 and Rowland 2003, a school travel co‐ordinator was provided, whose role was to undertake a range of actions designed to promote walking to school; in the case of Mendoza 2009, the main focus was co‐ordinating a walking school bus. In both cases, the intervention duration was a year, but the intensity of input from the travel co‐ordinator varied (10‐15 hours/week in Mendoza 2009; 16 hours per year in Rowland 2003). In Wen 2008, the 19 month intervention also included a wide range of actions to promote walking to school, but was led by a project advisory group rather than a co‐ordinator role, and the amount of input per week was unclear. The Department for Transport Studies (DfT 2005 Bracknell Forest, DfT 2005 Lancashire, DfT 2005 Redcar Cleveland, DfT 2005 Telford Wrekin) were likely to have similar activities, as described in a DfT Best Practice Guide for these interventions, however these were not described for each study. In McKee 2007 the intervention focused on classroom education and resources for children on active travel over a 10 week duration, while the two TAPESTRY studies (TAPESTRY Dublin 2003, TAPESTRY Herts 2003) included similar intervention components but only for a single week.

Four of the five workplace studies (Mutrie 2002, Sargeant 2004 Addenbrooke, Sargeant 2004 Car Park, Sargeant 2004 New Recruit) included the provision of advice and materials promoting active and sustainable travel (e.g. walking, cycling or public transport) to individual participants, without any intervention at the organisational level. In the fifth (Atherton 1982), the intervention was the adoption of a compressed work week, with participants working normal weekly hours over fewer days (either four‐day weeks or nine‐day fortnights).

The two studies based in tertiary education institutions used methods that differed significantly from the other studies. Nakayama 2005 evaluated a group‐based travel behaviour change programme in which group co‐ordinators were also seen as intervention participants (and changes in their travel behaviour were thus measured), and Jacobs 1982 evaluated the use of a promotion and education intervention to encourage car‐pooling.

Outcomes

Only one study (Mutrie 2002) measured health outcomes, which were the primary outcomes that our review considered. The health outcome measured in this study was health‐related quality of life, as measured by the Short Form 36 (SF‐36) instrument (Ware 1993).

All 17 studies measured changes in travel behaviour. No other relevant outcomes were measured by the included studies.

Travel behaviour change was measured in diverse ways by different studies. Most commonly, studies measured the proportions of participants using each different travel mode (e.g. car, walking, cycling, bus). Some studies grouped modes, e.g. into an 'other' category, or into 'eco friendly' travel modes (defined in Nakayama 2005 as walking, bus or train use, though cycling could also be considered 'eco friendly'). The measurement of travel mode use was complicated by participants using multiple travel modes, for instance Wen 2008 used categories such as 'walk all the way some days'. Other travel measures used included distance travelled by different modes and time spent using each mode, both of which require more information to calculate compared with the simple proportion of participants using each travel mode.

The different measures of travel mode used meant we were unable to directly compare results across all studies.

No studies presented data on the distribution of effects by ethnicity or socio‐economic status. Atherton 1982 reported that travel mode shift was similar among intervention group participants who 'represented a broad range of socioeconomic characteristics', but did not present any data to support this statement.

Other study characteristics

Of the 17 included studies, nine were identified by Internet searches (TAPESTRY Herts 2003, TAPESTRY Dublin 2003, Sargeant 2004 Addenbrooke, Sargeant 2004 Car Park, Sargeant 2004 New Recruit, DfT 2005 Redcar Cleveland, DfT 2005 Bracknell Forest, DfT 2005 Lancashire, DfT 2005 Telford Wrekin). The remaining eight studies were identified by searches of electronic databases. While this suggests that Internet searches were an important method of identifying studies, studies identified by this method were all judged to be at high risk of bias (see 'Risk of bias in included studies' section).

Excluded studies

See Characteristics of excluded studies.

Common reasons for excluding studies were as follows:

Study was a before‐after study that had no control group
Study was cross‐sectional only with no longitudinal component
Study was not carried out in the organisational setting
Study did not include a travel behaviour change intervention: that is, the intervention did not have travel behaviour change as a primary goal

Risk of bias in included studies

We assessed risk of bias according to the following criteria: sequence generation, allocation concealment, blinding, completeness of outcome data, selective reporting, matching of intervention and control groups and other bias. The criteria of sequence generation and allocation concealment were only able to be satisfied by studies using randomised designs.

Figure 1 and Figure 2 show the review authors' opinion on the risk of bias for each included study. Generally, more green (+ sign) results indicate lower risk of bias, and more red (‐ sign) results indicate a higher risk of bias. Yellow (? sign) results indicate that there was not sufficient information to properly assess risk of bias for that attribute; such results are not necessarily preferable to red (‐ sign) results, since they may indicate poor reporting of attributes that are relevant to the risk of bias.

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

Overall risk of bias was judged to be high for most included studies. Three studies (Rowland 2003, Wen 2008 and Mutrie 2002) were judged to have a low risk of bias on at least three of our criteria. A further two studies (McKee 2007 and Mendoza 2009) were judged to have a low risk of bias on two of our criteria, and the remaining studies were judged to have a low risk of bias on one criterion or no criteria.

In the DfT 2005 studies, the authors reported needing to 'carry out extensive data cleaning' and being 'constrained by the quality of the data available'. This suggests potential problems with the reliability of the results from these studies. However, similar data problems may also have been present, but not reported, in other studies, particularly those that were not peer reviewed.

Matching of intervention and control groups

Intervention and control groups were judged to be well matched in two of 17 studies (Rowland 2003, Mendoza 2009). In many studies, baseline travel mode differed substantially between intervention and control groups. In Wen 2008, there were important baseline differences between the intervention and control groups despite randomisation.

Sequence generation

Six studies were randomised, of which three were judged to have adequate sequence generation (Mutrie 2002, Rowland 2003, Wen 2008). The remaining three studies (Sargeant 2004 Addenbrooke, Sargeant 2004 Car Park, Sargeant 2004 New Recruit) did not report the sequence generation method used.

Allocation

Of the six randomised studies, three were judged to have adequate allocation concealment (Mutrie 2002, Rowland 2003, Wen 2008). The remaining three studies (Sargeant 2004 Addenbrooke, Sargeant 2004 Car Park, Sargeant 2004 New Recruit) used methods that may have introduced bias. Sargeant 2004 New Recruit reported that not all participants were randomly allocated.

Blinding

No studies blinded participants or those administering the intervention. We did not consider either to be feasible for these interventions, but the lack of blinding could bias the effect estimate away from the null.

Incomplete outcome data

Incomplete outcome data was well addressed in only five studies (Jacobs 1982, McKee 2007, Mutrie 2002, Rowland 2003, Wen 2008). This was a particular problem for controlled before‐after studies: some studies did not match follow‐up responses with baseline responses, meaning that participants in the follow‐up sample may have differed substantially from participants in the baseline sample. Several studies did not clearly report participant flow, making the risk of bias from incomplete outcome data unclear.

Selective reporting

There was insufficient information to determine whether outcomes were selectively reported for most studies. In Nakayama 2005 it appeared that a decision to exclude cycling from the analysis was made based on study results.

Effects of interventions

Our primary outcomes were addressed by one study (health‐related quality of life as measured by SF‐36). Our secondary outcomes were addressed by all 17 studies. All studies measured outcomes in intervention participants; no studies considered outcomes in the wider community. No studies addressed the distribution of effects across participant subgroups or impacts on health inequalities. No included studies measured injury outcomes, the most likely potential adverse effect of organisational travel plan interventions.

Primary outcomes

One study measured health outcomes directly. Mutrie 2002, a workplace intervention in people contemplating or preparing for active transport, found significantly greater improvements in SF‐36 scores for the intervention group compared with the control group, for the sub scales of mental health, vitality and general health. Changes in the five other SF‐36 sub scales (physical function, role limitations due to physical health, bodily pain, social function, and role limitations due to emotional health) were not significant.

Secondary outcomes

All included studies measured effects on travel mode use. Given the wide variation in study design, risk of bias and outcome measurement methods, we did not consider it appropriate to conduct a meta‐analysis.

Overall, reported intervention effects were mixed. A shift towards less car use was reported in 10 of 17 studies. Five studies reported no significant effect, and in two studies effects were mixed. However, many studies were judged to be at high risk of bias. We report below further detail on intervention effects for studies judged to have a lower risk of bias.

Rowland 2003, Wen 2008 and Mutrie 2002 were the studies judged to be at lowest risk of bias. Rowland 2003, a cluster randomised controlled trial, found no effect of the intervention on travel mode use, with an adjusted odds ratio (OR) for walking, cycling or using public transport of 0.98 (95% confidence interval [CI] 0.61 to 1.59). Given the wide confidence intervals, this study was unable to exclude a relatively large intervention effect.

Wen 2008, a cluster randomised controlled trial, found mixed results for travel mode. Student‐reported outcomes showed no significant differences in travel mode use in the intervention group. Parent‐reported outcomes showed that a significantly greater proportion of students increased their walking trips in the intervention group (29%) than in the control group (19%), though this difference was shown only for travel to school, and not travel from school.

In both Rowland 2003 and Wen 2008, interventions were able to influence a range of factors at the level of schools, individuals and other community agencies. The intervention in Wen 2008 appeared to be more intensive, though it was difficult to be certain of this from the intervention description. It is possible that the lack of intervention effect, particularly in Rowland 2003, was at least partly due to the low intensity of the intervention.

Mutrie 2002, a randomised controlled trial in the workplace setting, found that the intervention led to significantly greater increases in walking in both those who already walked to work at baseline, and those who did not walk to work at baseline. The intervention differed from Wen 2008 and Rowland 2003, being an interactive information pack and safety accessories. However, participants were a pre‐selected group who were already contemplating or preparing to actively commute.

Among the remaining studies, two were judged to be at less risk of bias than others. McKee 2007, a controlled before‐after study, found that active travel curriculum materials for teachers and classes, plus a child and family information pack, led to a significantly larger increase in mean distance walked to school in the intervention group (602 m) compared with the control group (47 m). There was also a significant decrease in mean distance travelled by car in the intervention group, which was not seen in the control group. However, average distance between home and school differed substantially for the intervention and control groups, which may have influenced the results.

Mendoza 2009, a controlled before‐after study, measured the effects of a walking school bus co‐ordinator on habitual travel to school (that is, travel to school on days when the walking school bus was not operating) and found that the proportion of children walking to school increased significantly in intervention schools (from 20% to 25%), but decreased significantly in control schools (from 15% to 7%). However, participant responses at baseline and follow‐up were not matched and it was possible that incomplete outcome data could have led to bias in the results, either towards or away from the null.

The remaining 12 studies were judged to be at high risk of bias. Of these, seven found a significant effect on travel mode in the direction of reduced car use. Four found no significant effects, and one showed mixed results.

Table: Summary of intervention effects on car use and other travel mode outcomes

Study abbreviation	Intervention and setting	Effect estimate for car use	Other comments	Number of criteria on which judged to have low risk of bias, and study design
Rowland 2003	School travel plan: multifactorial, ongoing intervention, targeting organisation as a whole as well as individual participants School setting	Car use at follow‐up 24% (intervention group), 22% (control group)	Adjusted odds for walking, cycling or using public transport in intervention schools compared with control schools was 0.98 (95% CI 0.61 to 1.59)	5 Cluster RCT
Wen 2008	School travel plan: multifactorial, ongoing intervention, targeting organisation as a whole as well as individual participants School setting	Student‐reported 'car use only' (i.e. no other travel modes used on trip to school) decreased by 8.3% in intervention group and decreased by 11.3% in control group (95% CI for difference: ‐14.1 to 20.1). Parents reported increased car use in 10.9% of intervention group and 16.8% of control group (95% CI for difference: ‐13.0 to 11.2), and decreased car use in 41.5% of intervention group and 32.1% of control group (95% CI for difference: ‐2.4 to 21.2). In summary, the effect on car use was not significant.	Greater increase in walking in intervention group compared with control group as reported by parents (9.8% greater; 95% CI: 0.7 to 18.9). No significant difference in student‐reported walking	4 Cluster RCT
Mutrie 2002	Advice and materials for individual participants promoting active and sustainable travel Workplace setting	Car use not reported	Increase in walking was 1.93 times higher in intervention than control group (95% CI: 1.06 to 3.52). No change in cycling.	3 RCT
McKee 2007	Active travel resources for school curriculum and for individual participants School setting	Decrease in distance travelled to school by car in intervention group was 850.5 m more than control group (95% CI: 445 to 1255)	Walking increased significantly more in intervention group	2 CBA
Mendoza 2009	School travel plan: multifactorial, ongoing intervention, targeting organisation as a whole as well as individual participants (main focus: walking school bus programme) School setting	Car use in intervention group 47% (before), 34% (after). Car use in control group 41% (before), 39% (after).	Change in car use not significantly different between intervention and control groups. Walking increased significantly more in intervention group.	2 CBA
DfT 2005 Bracknell Forest	School travel plan: multifactorial, ongoing intervention, targeting organisation as a whole as well as individual participants School setting	Car use in intervention group 46.0% (before), 45.2% (after). Car use in control group 44.6% (before), 45.0% (after).	Statistical significance of differences between intervention and control groups not reported	1 CBA
DfT 2005 Lancashire	School travel plan: multifactorial, ongoing intervention, targeting organisation as a whole as well as individual participants	Primary schools: car/taxi use in intervention group 50.2% (before), 57.3% (after); in control group 43.9% (before), 52.2% (after). Secondary schools: car/taxi use in intervention group 24.1% (before), 22.2% (after); in control group 24.3% (before), 26.7% (after).	Statistical significance of differences between intervention and control groups not reported	1 CBA
DfT 2005 Redcar Cleveland	School travel plan: multifactorial, ongoing intervention, targeting organisation as a whole as well as individual participants School setting	Primary schools: car use in intervention group 23.9% (before), 30.0% (after). Car use in control group 32.0% (before), 35.7% (after). Secondary schools: car use in intervention group 35.0% (before), 30.0% (after). Car use in control group 21.1% (before), 18.4% (after).	Statistical significance of differences between intervention and control groups not reported	1 CBA
DfT 2005 Telford Wrekin	School travel plan: multifactorial, ongoing intervention, targeting organisation as a whole as well as individual participants School setting	Car use in intervention group 52.5% (before), 50.8% (after). Car use in control group 44.9% (before), 49.5% (after).	Statistical significance of differences between intervention and control groups not reported	1 CBA
Jacobs 1982	Using information and financial incentives to promote carpooling University setting	Carpooling rates in intervention group A 11% (before), 21% (after); in intervention group B 11% (before), 14% (after). Carpooling rates in control group D 9.4% (before), 8.9% (after).	Statistical significance of differences between intervention and control groups not reported	1 CBA
Sargeant 2004 Addenbrooke	Advice and materials for individual participants promoting active and sustainable travel Workplace setting	Single‐occupant car use in intervention group 26.5% (before), 28.9% (after). Car use in control group 33.0% (before), 35.2% (after).	Statistical significance unclear	1 RCT
Sargeant 2004 Car Park	Advice and materials for individual participants promoting active and sustainable travel Workplace setting	Single‐occupant car use in intervention group 70.0% (before), 60.9% (after). Car use in control group 69.1% (before), 74.7% (after).	Statistical significance unclear	1 RCT
Sargeant 2004 New Recruit	Advice and materials for individual participants promoting active and sustainable travel Workplace setting	Single‐occupant car use in intervention group 45.5% (before), 45.1% (after). Car use in control group 51.9% (before), 56.2% (after).	Statistical significance unclear	1 RCT
TAPESTRY Dublin 2003	'Walk to School Week' School setting	Car use in intervention group 44% (before), 42% (after). Car use in control group 78% (before), 71% (after).	Report concluded 'there were no significant changes in behaviour'	1 CBA
TAPESTRY Herts 2003	'Walk to School Week' School setting	Car use in intervention group 51% (before), 52% (after). Car use in control group 46% (before), 46% (after).	Statistical significance unclear	1 CBA
Nakayama 2005	Group‐based travel behaviour change programme: travel behaviour change support group University setting	Car travel mileage reduced by 54% among group co‐ordinators and 48% among group participants, compared with 1% in non‐participants	Car travel reduction among both co‐ordinators and participants was significantly greater than non‐participants. Co‐ordinators also increased 'eco friendly mode use' (bus, train or walking) significantly more than non‐participants.	0 CBA
Atherton 1982	Compressed work week (working the same weekly hours, but over a four‐day week or a nine‐day fortnight) Workplace setting	Weekly household car travel mileage decreased by 20 miles/week (7%) in intervention group but increased by 30 miles/week (11%) in control group	Change in ridesharing in intervention group was no different from control group. The increase in transit use for central business district employees was smaller in the intervention group (3% increase) than control group (5% increase), but statistical significance was not reported	0 CBA

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RCT: Randomised controlled trial

CBA: Controlled before‐after study

Discussion

Summary of main results

We found 17 studies that met our inclusion criteria.

Two cluster randomised controlled trials of school travel plans demonstrated mixed effects on travel mode (Rowland 2003 and Wen 2008). Rowland 2003 involved a relatively low‐intensity intervention, and found no intervention effect, though confidence intervals were wide. Wen 2008 appeared to involve a higher intensity intervention, but found an intervention effect only for parent‐reported outcomes for the trip from home to school, and not for student‐reported outcomes or for the trip from school to home. Wen 2008 thus provided only weak support for an intervention effect, despite using a higher intensity intervention.

One randomised controlled trial in a workplace setting (Mutrie 2002), involving an information pack and safety accessories for staff already contemplating or preparing for walking to work, found increased walking and improved health as measured by SF‐36. It is therefore unknown whether such organisational travel plans would have effects in individuals who were not already in a primed state in terms of behaviour change.

Two controlled before‐after studies found that school travel interventions increased walking (McKee 2007 and Mendoza 2009).

The remaining studies identified by this review were judged to be at high risk of bias.

Overall completeness and applicability of evidence

We identified few robust studies of organisational travel plans. There is currently no evidence for an effect of organisational travel plans on any of the expected health outcomes, except in workers already preparing for or contemplating active travel (Mutrie 2002). There is very limited evidence that organisational travel plans influence travel mode, and much of this limited evidence applies to the school setting.

While all studies we identified were travel behaviour change programmes, only seven (Rowland 2003, Wen 2008, Mendoza 2009, DfT 2005 Bracknell Forest, DfT 2005 Lancashire, DfT 2005 Redcar Cleveland, DfT 2005 Telford Wrekin) included the multi‐component sustained interventions at both organisational and individual levels that are generally referred to as school or workplace 'travel plans'. None of these were conducted in the workplace setting. Other studies were of relatively specific interventions such as information packs for participants and/or educational resources, either of which may be one component within an organisational travel plan. The findings of these studies of more specific interventions are less applicable to organisational travel plans in general.

One study directly assessed health outcomes (Mutrie 2002), and was conducted in a pre‐selected group who were already contemplating or preparing for active travel. The results of this study therefore have limited applicability to organisational travel plans in general.

We identified no studies that assessed whether intervention effects are maintained over longer periods (e.g. years).

No studies were identified in low‐ or middle‐income country settings. One study (Mendoza 2009) was undertaken in a socioeconomically disadvantaged area of a high income country. However, no studies presented data on the social distribution of effects, e.g. whether the effects of these interventions differed by ethnicity or socioeconomic status.

Quality of the evidence

The overall quality of the evidence on the effectiveness of organisational travel plans is low to moderate, with most studies having multiple design limitations.

We identified two cluster randomised controlled trials (Rowland 2003, Wen 2008) and one well‐designed randomised controlled trial (Mutrie 2002) that were at lower risk of bias than other studies.

However, of these three studies, one was conducted in a pre‐selected group who were more likely to change their travel behaviour (Mutrie 2002), and the magnitude of effect is thus of limited applicability to other travel behaviour change interventions.

More robustly designed studies would enable clearer conclusions to be drawn about the effectiveness of organisational travel plans for improving health.

Potential biases in the review process

We carried out a systematic and sensitive search of electronic databases, complemented by review of a large number of web sites and several other sources of grey literature. However, organisational travel plans are poorly indexed in biomedical databases, and it appears likely that many evaluations of these interventions are not published in a form that is indexed by electronic databases. Despite our additional Internet searches, we may not have identified all relevant studies. Accordingly, we encourage authors of any potentially eligible studies not identified by this review to contact us.

Eleven of the seventeen studies that we identified for inclusion in this review were carried out in the United Kingdom. It is possible that travel plans may be more popular in the United Kingdom, or that greater efforts may have been made to evaluate travel plans in the United Kingdom than other countries. While we do not believe it is likely that our search of electronic databases was biased, there was more potential for bias in the list of websites we searched, which we adapted from a previous systematic review from the United Kingdom (Ogilvie 2004).

It was notable that all studies identified from Internet searches alone were judged to be at high risk of bias, suggesting that our searches of electronic databases may have identified the most robust studies. Nevertheless, publication bias in this review remains a possibility.

Agreements and disagreements with other studies or reviews

Cairns 2004 suggested that school travel plans were likely to lead to car use reductions in the order of 8‐15%, based on a narrative review of the literature that included uncontrolled evaluations. Ogilvie 2007, a systematic review, suggested that the evidence that interventions at an institutional level can promote walking was not convincing. Morrison 2003, reviewing findings from systematic reviews, found no evidence to suggest that any intervention is effective at achieving travel mode shift. Our findings are consistent with the findings of Morrison 2003 and Ogilvie 2007. While an 8‐15% decrease in car use from school travel plans can not be excluded at present, we consider that more robust studies are needed to establish whether or not these interventions lead to decreased car use, other travel mode changes or health effects.

Authors' conclusions

Implications for practice.

Significant emphasis is currently placed on organisational travel plans for changing the dominant mode of travel to work, school and tertiary education, with a number of environmental, social and physical health aims. Despite their considerable potential for influencing health through changing travel behaviour, evidence that organisational travel plans are effective is very limited. There is currently no evidence, outside pre‐selected highly motivated subgroups, that organisational travel plans have any effect on any health outcomes or risk factors that might be expected, such as injury, obesity, physical activity, air quality or social outcomes. Organisational travel plans are implemented in widely varying environmental contexts, which may impact significantly on their effectiveness. For instance, the safety of walking and cycling environments, and the accessibility of public transport are likely to be influential.

In practice, organisational travel plans should be considered complex health promotion interventions. Given lack of evidence for their effectiveness, the implementation of organisational travel plans should currently be in the context of robustly‐designed research studies, such as well‐designed cluster randomised trials.

Implications for research.

More robust studies are needed to assess the effectiveness of organisational travel plans for changing travel mode or improving health. In particular, designs that minimise selection bias through randomisation, and that include follow up of individual participants, are needed. More consistent follow up of adequate duration both before and after the intervention would allow secular time trends to be identified and separated from the effect of the intervention itself. In addition, having a longer duration of follow up, with a number of time points for measuring outcomes, would increase our understanding of whether the effects of the intervention are sustained over time, or whether they are cumulative, with increasing effect over time (plausible with an ongoing social intervention such as this).

Cluster randomised controlled trials appear to be a good study design for evaluating these interventions, and should be well designed to minimise the risk of bias. If a controlled before‐after study design is used in future studies, efforts will be needed to ensure intervention and control groups are well matched on baseline characteristics, and to ensure that the risk of bias from incomplete outcome data is minimised.

There is a particular lack of studies in the workplace setting, although additional studies in the school setting are also needed.

Studies included in this review used a range of different methods for measuring travel outcomes. Consistent and robust methods for measuring travel outcomes are needed in future studies. The direct measurement of physical activity, rather than just travel mode, where feasible, would enable more accurate assessment of the health effects of these interventions.

Since increased injury risk is a potential adverse effect from these interventions, it would be useful for future studies to measure injury outcomes. While travel mode shift from car use to walking is likely to increase physical activity and reduce air pollution, whether it will increase or reduce injuries is unclear. Injury outcomes will need to be measured directly, which may require different study designs, including mapping over large areas.

Future studies should include evaluation of the social distribution of effects, e.g. whether the effects of these interventions differ by ethnicity or socioeconomic status, to determine whether different strategies are needed for different population groups. This may include the tailoring of interventions for currently disadvantaged population groups, whose needs may differ in important ways from more privileged social groups (Collins 2005). Additional qualitative research in disadvantaged settings may be needed to inform such tailoring of interventions.

Acknowledgements

While undertaking previous work that informed this review, Jamie Hosking received funding from the Energy Efficiency and Conservation Authority (New Zealand), Land Transport New Zealand, Sport and Recreation New Zealand, and the Auckland Regional Public Health Service.

The assistance of the Cochrane Injuries Group was appreciated, particularly Karen Blackhall for searching the TRANSPORT database and Cochrane Injuries Group's Specialised Register.

Additional grey literature searching was undertaken by Shaheen Sultana.

Appendices

Appendix 1. MEDLINE search strategy

Transport Database (Ovid SP) 1988 to June 2008

1. (Travel* adj3 plan*).mp.   2. (Travel* adj3 behavio?r*).mp.   3. (Travel* adj5 modal shift*).mp.   4. ((Mobility or commut*) adj5 plan*).mp.   5. ((Journey* or travel* or commut*) adj3 (work* or school*)).mp.   6. or/1‐5   7. (promot* or shift* or substitut* or switch* or transfer* or chang* or modif* or alter*).mp.   8. 6 and 7   9. (Car?pool* or carpool* or car?shar* or carshar*).mp.   10. (Walk* or cycle* or cycli* or bicycle* or bike* or public transport or bus* or train* or rail* or teleworking or telecommuting or walking bus* or ecological commut* or ecological transport* or travelsmart or non‐auto* or non‐motori?e*).mp.   11. (green* adj3 (travel* or transport* or commut*)).mp.   12. ((activ* or health*) adj3 (travel* or transport* or commut*)).mp.   13. (ecological adj3 (travel* or transport* or commut*)).mp.   14. (eco?travel* or eco?transport* or eco?commut*).mp.   15. or/9‐14   16. 8 and 15

MEDLINE (OVID) 1950 to June 2008   1. (travel plan$ or transport plan$ or safe route$ or safer route$ or walking school bus$ or walking bus$ or ecological commut$ or ecological transport$ or mobility management plan$ or travel to work or commuter plan$ or travelsmart or walk to school).tw.   2. (Travel behaviour chang$ or travel behavior chang$).tw.   3. ((modal or mode) and (choice$ or distribution$ or selection$ or shift$ or split$ or substitut$ or switch$ or transfer$ or use$ or chang$ or modif$)).tw.   4. (travel$ or transportation$).tw. or transportation/   5. 3 and 4   6. (Automobile$ or auto use$ or car or cars or mechani#ed transport$ or motori#ed transport$ or motorist$ or personal transport$ or road use$ or motor vehic$ or vkt$ or vmt$ or vehicle kilomet$ or vehicle mile$ or (driv$ adj5 (school$ or work$))).tw. or motor vehicles/   7. (walk$ or (cyclist$ or cycling or bicycl$ or bik$) or (bus or buses or busing or bussing or (train or trains or rail or railway) or public transport$) or (carshar$ or carpool$ or (car$ adj shar$) or (car$ adj pool$)) or (non‐auto$ or non‐motori#ed) or (telework$ or telecommut$)).tw. or walking/ or bicycling/   8. 6 and 7   9. (active commut$ or utilitarian walk$ or utilitarian cycl$ or green travel$ or greener travel$ or green transport$ or greener transport$ or ecological commut$ or ecological transport$ or ecotravel$ or ecotransport$ or ecocommut$).tw. or (active transport$.tw. not exp biological transport/ not exp carrier proteins/)   10. 8 or 9   11. RANDOMIZED CONTROLLED TRIAL.pt.   12. CONTROLLED CLINICAL TRIAL.pt.   13. RANDOMIZED CONTROLLED TRIALS.sh.   14. RANDOM ALLOCATION.sh.   15. DOUBLE BLIND METHOD.sh.   16. SINGLE BLIND METHOD.sh.   17. or/11‐16   18. (ANIMALS not HUMAN).sh.   19. 17 not 18   20. CLINICAL TRIAL.pt.   21. exp CLINICAL TRIALS/   22. (clin$ adj25 trial$).ti,ab.   23. ((singl$ or doubl$ or trebl$ or tripl$) adj25 (blind$ or mask$)).ti,ab.   24. PLACEBOS.sh.   25. placebo$.ti,ab.   26. random$.ti,ab.   27. RESEARCH DESIGN.sh.   28. or/20‐27   29. 28 not 18   30. 29 not 19   31. COMPARATIVE STUDY.sh.   32. exp EVALUATION STUDIES/   33. FOLLOW UP STUDIES.sh.   34. PROSPECTIVE STUDIES.sh.   35. (control$ or prospectiv$ or volunteer$).ti,ab.   36. or/31‐35   37. 36 not 18   38. 37 not (19 or 30)   39. 19 or 30 or 38   40. 10 and 39   41. 1 or 2 or 5 or 40

EMBASE (OVID) 1947 to June 2008

1. (travel plan$ or transport plan$ or safe route$ or safer route$ or walking school bus$ or walking bus$ or ecological commut$ or ecological transport$ or mobility management plan$ or travel to work or commuter plan$ or travelsmart or walk to school).tw.   2. (Travel behaviour chang$ or travel behavior chang$).tw.   3. ((modal or mode) and (choice$ or distribution$ or selection$ or shift$ or split$ or substitut$ or switch$ or transfer$ or use$ or chang$ or modif$)).tw.   4. (travel$ or transportation$).tw. or transportation/   5. 3 and 4   6. (Automobile$ or auto use$ or car or cars or mechani#ed transport$ or motori#ed transport$ or motorist$ or personal transport$ or road use$ or motor vehic$ or vkt$ or vmt$ or vehicle kilomet$ or vehicle mile$ or (driv$ adj5 (school$ or work$))).tw. or motor vehicles/   7. (walk$ or (cyclist$ or cycling or bicycl$ or bik$) or (bus or buses or busing or bussing or (train or trains or rail or railway) or public transport$) or (carshar$ or carpool$ or (car$ adj shar$) or (car$ adj pool$)) or (non‐auto$ or non‐motori#ed) or (telework$ or telecommut$)).tw. or walking/ or bicycling/   8. 6 and 7   9. (active commut$ or utilitarian walk$ or utilitarian cycl$ or green travel$ or greener travel$ or green transport$ or greener transport$ or ecological commut$ or ecological transport$ or ecotravel$ or ecotransport$ or ecocommut$).tw. or (active transport$.tw. not exp biological transport/ not exp carrier proteins/)   10. 8 or 9   11. RANDOMIZED CONTROLLED TRIAL.tw.   12. CONTROLLED CLINICAL TRIAL.tw.   13. RANDOMIZED CONTROLLED TRIALS.tw.   14. RANDOM ALLOCATION.tw.   15. DOUBLE BLIND METHOD.tw.   16. SINGLE BLIND METHOD.tw.   17. or/11‐16   18. (ANIMALS not HUMAN).tw.   19. 17 not 18   20. CLINICAL TRIAL.tw.   21. exp CLINICAL TRIALS/   22. (clin$ adj25 trial$).ti,ab.   23. ((singl$ or doubl$ or trebl$ or tripl$) adj25 (blind$ or mask$)).ti,ab.   24. PLACEBOS.tw.   25. placebo$.ti,ab.   26. random$.ti,ab.   27. RESEARCH DESIGN.tw.   28. or/20‐27   29. 28 not 18   30. 29 not 19   31. COMPARATIVE STUDY.tw.   32. exp EVALUATION STUDIES/   33. FOLLOW UP STUDIES.tw.   34. PROSPECTIVE STUDIES.tw.   35. (control$ or prospectiv$ or volunteer$).ti,ab.   36. or/31‐35   37. 36 not 18   38. 37 not (19 or 30)   39. 19 or 30 or 38   40. 10 and 39   41. 1 or 2 or 5 or 40

CINAHL 1982 to June 2008

ERIC 1966 to June 2008

PSYCINFO 1806 to June 2008

Sociological Abstracts 1952 to June 2008

1. kw=travel plan* or transport plan* or safe route* or safer route* or walking school bus* or walking bus* or ecological commut* or ecological transport* or mobility management plan* or travel to work or commuter plan* or travelsmart or walk to school   2. kw=travel behaviour chang* or travel behavior chang*   3. kw=modal or mode   4. kw=choice* or distribution* or selection* or shift* or split* or substitut* or switch* or transfer* or use* or chang* or modif*   5. kw=travel* or transportation*   6. 3 and 4 and 5   7. kw=automobile* or auto use* or car or cars or mechani?ed transport* or motori?ed transport* or motorist* or personal transport* or road use* or motor vehic* or vkt* or vmt* or vehicle kilomet* or vehicle mile* or driv* within 1 school* or work*   8. kw=walk* or cyclist* or cycling or bicycl* or bik* or bus or buses or busing or bussing or train or trains or rail or railway or public transport* or carshar* or carpool* or (car or cars) within 3 shar* or (car or cars) within 3 pool* or non‐auto* or non‐motori?ed or telework* or telecommut*   9. 7 and 8   10. kw=active commut* or utilitarian walk* or utilitarian cycl* or green travel* or greener travel* or green transport* or greener transport* or ecological commut* or ecological transport* or ecotravel* or ecotransport* or ecocommut* or active transport*   11. 8 or 9   12. 1 or 2 or 6 or 11

BUILD 1989 to 2002 (database includes some earlier material from 1945‐)

1. travel plan* or transport plan* or safe route* or safer route* or walking school bus* or walking bus* or ecological commut* or ecological transport* or mobility management plan* or travel to work or commuter plan* or travelsmart or walk to school   2. travel behaviour chang* or travel behavior chang*   3. (modal or mode) and (choice* or distribution* or selection* or shift* or split* or substitut* or switch* or transfer* or use* or chang* or modif*)   4. travel* or transportation*   5. 3 and 4   6. (automobile* or auto use* or car or cars or mechani?ed transport* or motori?ed transport* or motorist* or personal transport* or road use* or motor vehic* or vkt* or vmt* or vehicle kilomet* or vehicle mile* or (driv* %5 (school* or work*)))   7. walk* or (cyclist* or cycling or bicycl* or bik*) or (bus or buses or busing or bussing) or (train or trains or rail or railway) or public transport* or (carshar* or carpool* or (car* % shar*) or (car* % pool*)) or (non*auto* or non*motori*ed) or (telework* or telecommut*)   8. 6 and 7   9. active commut* or utilitarian walk* or utilitarian cycl* or green travel* or greener travel* or green transport* or greener transport* or ecological commut* or ecological transport* or ecotravel* or ecotransport* or ecocommut* or active transport* or sustainable transport*   10. 8 or 9   11. 1 or 2 or 5 or 10

Social Sciences Citation Index (1900 to June 2008), Science Citation Index (1900 to June 2008), Arts & Humanities Index (1975 to June 2008). Via Web of Science

1. "travel plan*" OR "transport plan*" OR "safe route*" OR "safer route*" OR "walking school bus*" OR "walking bus*" OR "ecological commut*" OR "ecological transport*" OR "mobility management plan*" OR "travel to work" OR "commuter plan*" OR "travelsmart" OR "walk to school"   2. "travel behaviour chang*" OR "travel behavior chang*"   3. (modal OR mode) AND (choice* OR distribution* OR selection* OR shift* OR split* OR substitut* OR switch* OR transfer* OR use* OR chang* OR modif*)   4. travel* OR transportation*   5. 3 AND 4   6. (automobile* OR "auto use*" OR car OR cars OR "mechani?ed transport*" OR "motori?ed transport*" OR motorist* OR "personal transport*" OR "road use*" OR "motor vehic*" OR vkt* OR vmt* OR "vehicle kilomet*" OR "vehicle mile*" OR (driv* SAME (school* OR work*)))   7. (car or "driving to school" or "driving to work") AND (walk* or cycle or bus or train)   8. 6 AND 7   9. "active commut*" OR "utilitarian walk*" OR "utilitarian cycl*" OR "green travel*" OR "greener travel*" OR "green transport*" OR "greener transport*" OR "ecological commut*" OR "ecological transport*" OR ecotravel* OR ecotransport* OR ecocommut* OR "sustainable transport*"   10. 8 OR 9   11. 1 OR 2 OR 5 OR 10

Cochrane Database of Systematic Reviews (OVID) to August 2008

CENTRAL (OVID) to August 2008

Cochrane Injuries Group Register (to December 2009)

1. Travel* and plan*   2. Travel* and behavior*   3. Travel* and “modal shift"   4. (Mobility or commut*) and plan*   5. (Journey* or travel* or commut*) and (work* or school*)   6. 1 or 2 or 3 or 4 or 5

Campbell Collaboration database C2‐RIPE (Reviews of Interventions, and Policy Evaluations) to July 2008

All citations reviewed

Campbell Collaboration database C2‐SPECTR (Social, Psychological, Education, and Criminological Trials Registry) to July 2008

1. {travel plan} OR {transport plan} OR {safe route} OR {safer route} OR {walking school bus} OR {walking bus} OR {ecological commut}   2. {ecological transport} OR {mobility management plan} OR {travel to work} OR {commuter plan} OR {travelsmart} OR {walk to school}   3. {travel behaviour chang} OR {travel behavior chang}   4. {travel mode shift}   5. {active commut} OR {utilitarian walk} OR {utilitarian cycl} OR {ecological commut} OR {ecological transport} OR {ecotravel} OR {ecotransport} OR {ecocommut} OR {sustainable transport}   6. {car} OR {driving to school} OR {driving to work}   7. {walk} OR {cycle} OR {bus} OR {train}   8. 6 and 7   9. 1 or 2 or 3 or 4 or 5 or 8

ProQuest Dissertations & Theses (formerly known as Digital Dissertations) 1861 to June 2008

1. "travel plan*" OR "transport plan*" OR "safe route*" OR "safer route*" OR "walking school bus*" OR "walking bus*" OR "ecological commut*"   2. "ecological transport*" OR "mobility management plan*" OR "travel to work" OR "commuter plan*" OR "travelsmart" OR "walk to school"   3. "travel behaviour chang*" OR "travel behavior chang*"   4. "travel mode shift"   5. (car or "driving to school" or "driving to work") AND (walk* or cycle or bus or train)   6. "active commut*" OR "utilitarian walk*" OR "utilitarian cycl*" OR "ecological commut*" OR "ecological transport*" OR ecotravel* OR ecotransport* OR ecocommut* OR "sustainable transport*"   1 OR 2 OR 3 OR 4 OR 5 OR 6

Appendix 2. Websites searched

We searched the following list of websites, which was adapted from Ogilvie 2004:

1. www.activelivingresearch.org   2. www.certu.fr   3. www.dft.gov.uk/   4. www.dpi.wa.gov.au/travelsmart   5. www.eltis.org   6. www.energie‐cites.org   7. www.epomm.eu   8. www.ibike.org/bibliography/bike‐policy.htm   9. www.iwalktoschool.org/   10. www.nas.edu/trb   11. www.nottingham.ac.uk/sbe/planbiblios   12. www.ntl.bts.gov   13. www.scotland.gov.uk   14. www.sustrans.org   15. www.tdmcentral.net   16. www.toi.no   17. www.transguide.org   18. www.transport.sa.gov.au/environment/travelsmartsa   19. www.travelsmart.gov.au   20. www.travelsmart.vic.gov.au   21. www.trl.co.uk   22. www.trm.dk and www.vd.dk   23. www.ucl.ac.uk/transport‐studies   24. www.vtpi.org/tdm   25. www.tc.gc.ca/programs/environment/most/menu.htm   26. www.walktoschool‐usa.org/

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Atherton 1982.

Methods	Design: Controlled before‐after study Duration of follow‐up: Up to 12 months
Participants	Country: United States Setting: Urban workplaces Intervention group: 594 employees from an unknown number of workplaces (total of 29 agencies between intervention and control groups, but not reported separately) Control group: 154 employees from an unknown number of workplaces Age: working age. Gender not reported
Interventions	Adoption of a compressed work week, with participants working normal weekly hours over fewer days (either four‐day weeks or nine‐day fortnights)
Outcomes	Weekly household vehicle miles travelled Rideshare and transit use Vehicle emissions outcomes apparently estimated based on vehicle miles travelled
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	High risk	Not randomised
Allocation concealment?	High risk	Not randomised
Blinding?   All outcomes	High risk	Blinding not feasible. Could have influenced outcomes
Incomplete outcome data addressed?   All outcomes	High risk	2309 employees surveyed at baseline (combined intervention and control groups) but primary outcome measure (weekly household vehicle miles travelled) reported for only 748 (32%). 2464 employees surveyed at 12 month follow‐up (combined intervention and control groups) but primary outcome measure reported for only 533 (22%). Results for agencies in the central business district were excluded due to 'an insufficient number of observations for this group'. Thus, a substantial amount of incomplete outcome data. Participant numbers were not always reported separately for intervention and control groups, making it difficult to fully assess incomplete outcome data.
Free of selective reporting?	Unclear risk	Not clear that all pre‐specified outcomes were included
Free of other bias?	Unclear risk	Numbers of workplaces in intervention and control groups were not reported. Participant numbers were not always reported separately for intervention and control groups, making it difficult to fully assess risk of bias.
Adequate matching of intervention / control groups?	Unclear risk	Travel mode at baseline similar for intervention and control groups. Demographic characteristics for each group were measured but data not presented. The authors reported that 'participation rates among employees that have different socioeconomic characteristics can vary considerably', suggesting socio‐economic differences between intervention and control groups, but did not present data to support this

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DfT 2005 Bracknell Forest.

Methods	Design: Controlled before‐after study Duration of follow‐up: Minimum of 6 months, maximum of 9 months post‐intervention (varies between schools, depending on intervention start date)
Participants	Country: United Kingdom Setting: Urban primary schools Intervention group: 3 schools, 828 baseline responses Control group: 15 schools, 3043 baseline responses Age: primary schoolchildren. Gender not reported
Interventions	School travel advisors appointed to work with schools to develop school travel plans School travel advisors also do other work that contribute to reducing congestion and increasing sustainable travel. Capital grants made available for some school travel plans Duration of intervention: 6‐9 months (varies between schools, depending on intervention start date)
Outcomes	Travel mode: ‐ How pupils travelled to school every day for one week (averaged) ‐ % of pupils travelling by car, walking, cycling, using other travel mode. Effects on inequalities not reported. Adverse effects not reported.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	High risk	Not randomised
Allocation concealment?	High risk	Not randomised
Blinding?   All outcomes	High risk	Blinding not feasible. Could have influenced outcomes.
Incomplete outcome data addressed?   All outcomes	High risk	57% of eligible schools provided results at both baseline and follow‐up: a substantial amount of incomplete outcome data. Some school results removed due to 'cleaning the data'. No matching of individual participants in baseline and follow‐up samples, so not possible to fully assess the extent to which incomplete outcome data may have led to bias in the results
Free of selective reporting?	Unclear risk	Not clear that all pre‐specified outcomes were included
Free of other bias?	Low risk	No other sources of bias identified
Adequate matching of intervention / control groups?	Unclear risk	Selected schools were those with suitable data. Intervention and control schools were in same region. Travel mode at baseline similar for intervention and control schools.

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DfT 2005 Lancashire.

Methods	Design: Controlled before‐after study Duration of follow‐up: Minimum of 2 months, maximum of 3 years and 3 months post‐intervention (varies between schools, depending on intervention start date)
Participants	Country: United Kingdom Setting: Primary (rural and urban) and secondary (urban) schools Intervention group: 20 schools, 4714 baseline responses Control group: 217 schools, 42712 baseline responses Age: Primary and secondary schoolchildren. Gender not reported
Interventions	School travel advisors appointed to work with schools to develop school travel plans School travel advisors also do other work that contributes to reducing congestion and increasing sustainable travel. Capital grants made available for some school travel plans Duration of intervention: from 3 months to 3 years and 3 months (varies between schools, depending on intervention start date)
Outcomes	Travel mode: ‐ How pupils usually travel to school ‐ % of pupils travelling by walking, car/taxi, cycling, bus, other travel mode Effects on inequalities not reported. Adverse effects not reported.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	High risk	Not randomised
Allocation concealment?	High risk	Not randomised
Blinding?   All outcomes	High risk	Blinding not feasible. Could have influenced outcomes.
Incomplete outcome data addressed?   All outcomes	High risk	38% of eligible schools provided adequate data at both baseline and follow‐up: a substantial amount of incomplete outcome data. Some school results removed due to 'cleaning the data'. No matching of individual participants in baseline and follow‐up samples, so not possible to fully assess the extent to which incomplete outcome data may have led to bias in the results
Free of selective reporting?	Unclear risk	Not clear that all pre‐specified outcomes were included
Free of other bias?	Low risk	No other sources of bias identified
Adequate matching of intervention / control groups?	High risk	Selected schools were those with suitable data. Intervention and control schools were in same region. Travel mode at baseline differed substantially between intervention and control schools. Baseline primary school car/taxi use was 50.2% in intervention schools and 43.9% in control schools.

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DfT 2005 Redcar Cleveland.

Methods	Design: Controlled before‐after study Duration of follow‐up: 0‐2 years post‐intervention (varies between schools, depending on intervention start date)
Participants	Country: United Kingdom Setting: Primary schools and urban secondary schools Intervention groups: 10 primary schools, 2341 baseline responses; 1 secondary school, 1265 baseline responses Control groups: 34 primary schools, 8298 baseline responses; 2 secondary schools, 1571 baseline responses Age: primary and secondary schoolchildren. Gender not reported
Interventions	School travel advisors appointed to work with schools to develop school travel plans School travel advisors also do other work that contribute to reducing congestion and increasing sustainable travel. Capital grants made available for some school travel plans Duration of intervention: 0‐2 years (varies between schools, depending on intervention start date)
Outcomes	Travel mode to school: ‐ % of pupils travelling by car, walking, cycling, bus, other travel mode Effects on inequalities not reported. Adverse effects not reported.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	High risk	Not randomised
Allocation concealment?	High risk	Not randomised
Blinding?   All outcomes	High risk	Blinding not feasible. Could have influenced outcomes.
Incomplete outcome data addressed?   All outcomes	Unclear risk	Approximately 77% of baseline schools also provided results at follow‐up: moderate loss to follow‐up. Some school results removed due to 'cleaning the data'. No matching of individual participants in baseline and follow‐up samples, so not possible to fully assess the extent to which incomplete outcome data may have led to bias in the results
Free of selective reporting?	Unclear risk	Not clear that all pre‐specified outcomes were included
Free of other bias?	Low risk	No other sources of bias identified
Adequate matching of intervention / control groups?	High risk	Selected schools were those with suitable data. Intervention and control schools were in same region. Travel mode at baseline differed substantially between intervention and control schools. Baseline primary school car use was 23.9% in intervention schools and 32.0% in control schools.

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DfT 2005 Telford Wrekin.

Methods	Design: Controlled before‐after study Duration of follow‐up: from 2 months to 3 years and 5 months post‐intervention (varies between schools, depending on intervention start date)
Participants	Country: United Kingdom Setting: Urban and rural primary schools Intervention group: 8 schools, 1712 baseline responses Control group: 21 schools, 4648 baseline responses Age: primary schoolchildren. Gender not reported
Interventions	School travel advisors appointed to work with schools to develop school travel plans School travel advisors also do other work that contribute to reducing congestion and increasing sustainable travel. Capital grants made available for some school travel plans Duration of intervention: from 2 months to 3 years and 5 months (varies between schools, depending on intervention start date)
Outcomes	Travel mode: ‐ How pupils normally travel to and from school ‐ % of pupils travelling by car, walking, cycling, bus, other travel mode Effects on inequalities not reported. Adverse effects not reported.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	High risk	Not randomised
Allocation concealment?	High risk	Not randomised
Blinding?   All outcomes	High risk	Blinding not feasible. Could have influenced outcomes.
Incomplete outcome data addressed?   All outcomes	High risk	33% of eligible schools provided adequate data at both baseline and follow‐up: a substantial amount of incomplete outcome data. Some school results removed due to 'cleaning the data'. No matching of individual participants in baseline and follow‐up samples, so not possible to fully assess the extent to which incomplete outcome data may have led to bias in the results
Free of selective reporting?	Unclear risk	Not clear that all pre‐specified outcomes were included
Free of other bias?	Low risk	No other sources of bias identified
Adequate matching of intervention / control groups?	High risk	Selected schools were those with suitable data. Intervention and control schools were in same region. Travel mode at baseline differed substantially between intervention and control schools. Baseline car use was 52.5% in intervention schools and 44.9% in control schools.

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Jacobs 1982.

Methods	Design: Controlled before‐after study. Three intervention groups (two treatment arms) and one control group. Duration of follow‐up: 30 days
Participants	Country: USA Setting: University Intervention groups: number of participants not reported. Number of available parking spaces in intervention parking lots were: lot A n=130, lot B n=580, lot C n=186. Control group: number of participants not reported. Number of available parking spaces in control parking lot (lot D) was n=102. Age, gender not reported.
Interventions	Interventions were delivered at the level of the parking lot. Lot A: Drivers entering this lot received a flier with carpooling information. Car occupants were also matched with other potential carpoolers. Reserved parking was provided for carpoolers in this parking lot. A 25c coupon was provided to each occupant each time they parked in the reserved parking for carpoolers (days 10‐28 only) Lot B: Drivers entering this lot received a flier with carpooling information. Car occupants were also matched with other potential carpoolers. Reserved parking was provided for carpoolers in this parking lot. A 25c coupon was provided to each occupant each time they parked in the reserved parking for carpoolers (days 10‐39) Lot C: Drivers entering this lot received a flier with carpooling information. Car occupants were also matched with other potential carpoolers. Drivers were informed that reserved parking for carpoolers was provided in parking lots A and B (but not in this parking lot). Lot D: No intervention. Duration of intervention: 30 days
Outcomes	% of vehicles in car park carpooling each day (with >1 occupant) Effects on inequalities not reported. Adverse effects not reported.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	High risk	Not randomised
Allocation concealment?	High risk	Not randomised
Blinding?   All outcomes	High risk	Not feasible. Could have influenced outcomes
Incomplete outcome data addressed?   All outcomes	Low risk	All carparks followed up for full duration
Free of selective reporting?	Unclear risk	Not clear that all pre‐specified outcomes were included
Free of other bias?	High risk	Potential for carpoolers to migrate from lot C to lots A and B not robustly assessed. Could lead to overestimate of carpooling increases in lots A and B.
Adequate matching of intervention / control groups?	High risk	Groups (and their associated parking lots) were of very different sizes and staff:student ratios.

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McKee 2007.

Methods	Design: Controlled before‐after study Duration of follow‐up:10 weeks
Participants	Country: United Kingdom Setting: Primary schools in two villages in Scotland Intervention group: 1 school class, 31 children Control group: 1 school class, 29 children Age: mean age 9 years, range 9‐10 years. Gender: 60% female.
Interventions	Curriculum materials about active travel for teachers and school classes Child and family information pack: advice on how to plan an active journey to school Duration of intervention: 10 weeks
Outcomes	Mean distance travelled to school by car and by walking Effects on inequalities not reported. Adverse effects not reported.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	High risk	Not randomised
Allocation concealment?	High risk	Not randomised
Blinding?   All outcomes	High risk	Not feasible. Could have influenced outcomes
Incomplete outcome data addressed?   All outcomes	Low risk	Response rate for 'after' survey 92%.
Free of selective reporting?	Unclear risk	Not clear that all pre‐specified outcomes were included
Free of other bias?	Low risk	No other sources of bias identified
Adequate matching of intervention / control groups?	High risk	Similar demographic profiles of schools, and located 5km apart. Mean distance from school differed significantly between groups (intervention group 2215m, control group 1174m). Baseline travel mode differed substantially between schools. Mean distance travelled to school by car at baseline was 2018m in intervention group and 933m in control group.

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Mendoza 2009.

Methods	Design: Controlled before‐after study One intervention group and two control groups Duration of follow‐up: 1 month, 6 months and 12 months
Participants	Country: Washington (state), USA Setting: Urban primary schools Intervention group: 1 school, 347 children Control group: 2 schools, 473 (293+180) children Age: 5‐11; Gender: female 44% (intervention school), 43% and 52% (control schools) Socioeconomically disadvantaged schools
Interventions	Walking school bus (WSB) co‐ordinator for 10‐15 hours per week Designed WSB routes WSB operated 1‐2 days per week according to volunteer availability; parent volunteers recruited to run WSB Promotional material and events Pedestrian safety activities Duration of intervention: 12 months
Outcomes	Travel to school on day of survey (hands‐up survey). Survey conducted on day when WSB not operating and no other promotional event operating Effects on inequalities not reported Adverse effects not reported
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	High risk	Not randomised
Allocation concealment?	High risk	Not randomised
Blinding?   All outcomes	High risk	Not feasible. Could have influenced outcomes
Incomplete outcome data addressed?   All outcomes	Unclear risk	No matching of participants in baseline and follow‐up samples, so not possible to fully assess attrition. From the data provided, we estimated intervention group response rates to be 81% (baseline) and 87% (12 months), while control group response rates were 79% (baseline) and 72% (12 months)
Free of selective reporting?	Unclear risk	Not clear that all pre‐specified outcomes were included
Free of other bias?	Low risk	No other sources of bias identified
Adequate matching of intervention / control groups?	Low risk	Similar neighbourhood attributes and travel mode use at baseline

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Mutrie 2002.

Methods	Design: Randomised controlled trial. Control group then received intervention at 6 months. Duration of follow‐up: 6 and 12 months
Participants	Country: United Kingdom Setting: Three city workplaces in Glasgow, Scotland Intervention group n=145 Control group n=150 Mean age 38 years (range 19‐69). 64% women. 76% were social economic class 1 or 2. 70% travelled between 2 and 10 miles to work.
Interventions	'Walk in to work out' pack: written interactive self‐help materials to support active travel; reflective safety accessories Duration of intervention: pack delivered at baseline, with no further subsequent intervention
Outcomes	SF‐36 including sub scales Minutes per week spent walking to work. Effects on inequalities not reported. Adverse effects not reported.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	Low risk	Randomised by automatic data management system
Allocation concealment?	Low risk	Randomisation process not accessible to the research assistant entering the data
Blinding?   All outcomes	High risk	Not feasible for participants or those administering intervention. Statistician blind to group identity. Could have influenced outcomes
Incomplete outcome data addressed?   All outcomes	High risk	34% of participants lost to follow up at 6 months (30% intervention group, 39% control). Reason for missing outcome data could be related to outcome. Loss to follow up greater in control group
Free of selective reporting?	Unclear risk	Not clear that all pre‐specified outcomes were included
Free of other bias?	Low risk	No other sources of bias identified
Adequate matching of intervention / control groups?	Unclear risk	Randomised but baseline demographic data not reported. Participants in intervention and control group matched by distance travelled to work

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Nakayama 2005.

Methods	Design: Controlled before and after study Two intervention groups, one control group. Duration of follow‐up: 2 months
Participants	Country: Japan Setting: Two tertiary education institutions Intervention groups: Coordinators n=15. Participants n=44. Control group n= 92. Age: third and fourth‐year tertiary students. Gender not reported.
Interventions	A program organiser trains ecotravel co‐ordinators. Ecotravel co‐ordinators organise meetings with participants, and provide advice on reducing car use. Duration of intervention: 2 months.
Outcomes	Travel mode: ‐ Car mileage ‐ Frequency of 'eco friendly mode' use (bus, train and walking) Effects on inequalities not reported. Adverse effects not reported.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	High risk	Not randomised
Allocation concealment?	High risk	Not randomised
Blinding?   All outcomes	High risk	Not feasible. Could have influenced outcome.
Incomplete outcome data addressed?   All outcomes	High risk	Loss to follow‐up at second survey ranges from 27‐39%. Reasons not explored but could be associated with outcome.
Free of selective reporting?	High risk	Cycling was discussed but not reported on: "bike use depends highly on weather and is very changeable; therefore it is not considered in the analysis" p.228
Free of other bias?	High risk	Individual participants self‐selected to study groups
Adequate matching of intervention / control groups?	High risk	Control group had substantially lower rates of 'ecofriendly mode use' at baseline. Baseline 'ecofriendly mode use' frequency was 8.01 in control group, compared with 15.73 in co‐ordinator group.

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Rowland 2003.

Methods	Design: Cluster‐randomised controlled trial Duration of follow‐up: 14 months
Participants	Country: United Kingdom Setting: Urban primary schools Intervention group n=714 Control group n=672 Age: year 2 & 5 primary schoolchildren. 56% female (intervention group), 49% female (control group).
Interventions	16 hours of expert assistance from school travel co‐ordinators over one year. School travel co‐ordinators provide advice on road safety and travel plan development, and facilitate travel plan implementation. Duration of intervention: 14 months
Outcomes	Travel mode: mode of travel to school on the day of the survey Effects on inequalities not reported. Adverse effects not reported.
Notes	2 of 11 intervention schools opted out of the project following randomisation. Analysis adjusted for baseline travel.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	Low risk	Randomisation by software programme
Allocation concealment?	Low risk	Randomisation by independent statistician
Blinding?   All outcomes	High risk	Not feasible. Could have influenced outcome.
Incomplete outcome data addressed?   All outcomes	Low risk	95% of schools completed follow‐up survey, and 85% of children in those schools completed the survey. Thus, loss to follow‐up relatively small.
Free of selective reporting?	Unclear risk	Not clear that all pre‐specified outcomes were included
Free of other bias?	Low risk	No other sources of bias identified
Adequate matching of intervention / control groups?	Low risk	Randomised. Similar at baseline except for presence of other safety programmes (intervention schools 55%, control schools 30%) ‐ unlikely to have had a major effect on travel mode outcomes

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Sargeant 2004 Addenbrooke.

Methods	Design: Randomised controlled trial Duration of follow‐up: 3 months
Participants	Country: United Kingdom Urban workplace Intervention group n=158 Control group n=172 Age, gender not reported; however, they are working age adults
Interventions	Personalised travel advice Travel information pack Ongoing travel advice updates Duration of intervention: 3 months
Outcomes	Travel mode: ‐ % of trips alone by car in preceding 5 working days ‐ % of participants who travelled alone by car for all of preceding 5 working days
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	High risk	Sequence generation method not reported
Allocation concealment?	High risk	Allocation concealment method not reported. Included a non‐random allocation component.
Blinding?   All outcomes	High risk	Blinding not feasible. Could have influenced outcomes.
Incomplete outcome data addressed?   All outcomes	High risk	Loss to follow‐up known to have occurred but participant flow not clearly reported
Free of selective reporting?	Unclear risk	Not clear that all pre‐specified outcomes were included
Free of other bias?	Low risk	No other sources of bias identified
Adequate matching of intervention / control groups?	High risk	Apparently substantial baseline differences in travel mode between intervention and control groups despite randomisation. Baseline car use was 26.5% in intervention group and 33.0% in control group.

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Sargeant 2004 Car Park.

Methods	Design: Randomised controlled trial Duration of follow‐up: 3 months
Participants	Country: United Kingdom Urban workplace Intervention group n=145 Control group n=136 Age, gender not reported; however, they are working age adults
Interventions	Personalised travel advice Travel information pack Ongoing travel advice updates Duration of intervention: 3 months
Outcomes	Travel mode: ‐ % of trips alone by car in preceding 5 working days ‐ % of participants who travelled alone by car for all of preceding 5 working days
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	High risk	Sequence generation method not reported
Allocation concealment?	High risk	Assigned to groups alternately 'at random' from an alphabetical list
Blinding?   All outcomes	High risk	Blinding not feasible. Could have influenced outcomes.
Incomplete outcome data addressed?   All outcomes	High risk	Loss to follow‐up known to have occurred but participant flow not clearly reported
Free of selective reporting?	Unclear risk	Not clear that all pre‐specified outcomes were included
Free of other bias?	Low risk	No other sources of bias identified
Adequate matching of intervention / control groups?	High risk	Apparently substantial baseline differences in travel mode between intervention and control groups despite randomisation. At baseline, the percentage of individuals driving alone for five days a week in the intervention group was 56.6%, and in the control group was 44.1%.

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Sargeant 2004 New Recruit.

Methods	Design: Randomised controlled trial Duration of follow‐up: 3 months
Participants	Country: United Kingdom Urban workplace Intervention group n=55 Control group n=47 Age, gender not reported; however, they are working age adults
Interventions	Personalised travel advice Travel information pack Ongoing travel advice updates Duration of intervention: 3 months
Outcomes	Travel mode: ‐ % of trips alone by car in preceding 5 working days ‐ % of participants who travelled alone by car for all of preceding 5 working days
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	High risk	Sequence generation method not reported
Allocation concealment?	High risk	Allocation concealment method not reported
Blinding?   All outcomes	High risk	Blinding not feasible. Could have influenced outcomes
Incomplete outcome data addressed?   All outcomes	High risk	Loss to follow‐up known to have occurred but participant flow not clearly reported
Free of selective reporting?	Unclear risk	Not clear that all pre‐specified outcomes were included
Free of other bias?	Low risk	No other sources of bias identified
Adequate matching of intervention / control groups?	High risk	Apparently substantial baseline differences in travel mode between intervention and control groups despite randomisation. Baseline car use was 45.5% in intervention group and 51.9% in control group.

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TAPESTRY Dublin 2003.

Methods	Design: Controlled before‐after study Duration of follow‐up:1 month
Participants	Country: Ireland Setting: Urban and rural primary schools Intervention group: 4 schools, 230 baseline responses Control group: 2 schools, 38 baseline responses Age 11‐12 years. Gender not reported
Interventions	Walk to school week ‐ information packs for students and parents ‐ other promotional material on walking to school (posters etc.) ‐ children walking or cycling to school were eligible for prizes, as were schools ‐ additional infrastructure for walking/cycling in conjunction with campaign Duration of intervention: 1 week
Outcomes	Usual mode of travel to school Effects on inequalities not reported. Adverse effects not reported.
Notes	Parts of report very poorly written and structured, and difficult to interpret
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	High risk	Not randomised
Allocation concealment?	High risk	Not randomised
Blinding?   All outcomes	High risk	Not feasible. Could have influenced outcomes
Incomplete outcome data addressed?   All outcomes	Low risk	100% response rate at follow up survey
Free of selective reporting?	Unclear risk	Not clear that all pre‐specified outcomes were included
Free of other bias?	High risk	Apparently inconsistent results reported in paper without clear explanation. Possible errors in data or reporting. A further school class was added at the time of the follow up survey
Adequate matching of intervention / control groups?	High risk	Baseline travel mode differed substantially between intervention and control groups. Baseline car use was 44% in intervention schools and 78% in control schools. Intervention schools were within the city limits, while control schools were outside the jurisdiction of the city council and appeared to be rural.

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TAPESTRY Herts 2003.

Methods	Design: Controlled before‐after study Duration of follow‐up: 3 weeks
Participants	Country: United Kingdom Setting: Urban primary schools in North Hertfordshire Intervention group: 11 schools, 1846 baseline responses Control group: 2 schools, 347 baseline responses Age: primary schoolchildren. Gender not reported.
Interventions	Walk to school campaign: ‐ Education packs linked to curriculum ‐ Promotional material: posters, banners etc. Duration of intervention: 1 week
Outcomes	Travel mode: proportion of children using mode at least once per week (walking, car, cycling) Effects on inequalities not reported. Adverse effects not reported.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	High risk	Not randomised
Allocation concealment?	High risk	Not randomised
Blinding?   All outcomes	High risk	Not feasible. Could have influenced outcomes
Incomplete outcome data addressed?   All outcomes	High risk	Approximately 52% of baseline survey responses had a matched post‐intervention survey response, so loss to follow‐up high. Could be associated with outcome
Free of selective reporting?	Unclear risk	Not clear that all pre‐specified outcomes were included
Free of other bias?	Low risk	No other sources of bias identified
Adequate matching of intervention / control groups?	Unclear risk	Schools appear to have self‐selected to intervention or control with no apparent attempt at matching. Baseline travel mode data relatively similar, however

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Wen 2008.

Methods	Design: Cluster‐randomised controlled trial Duration of follow‐up: 19 months
Participants	Country: Australia Setting: Urban primary schools Intervention group: 12 schools, 1094 baseline responses Control group: 12 schools, 1164 baseline responses Age: 10‐11 years. Gender: 52% female. 54% lived within 1 km of school. 45% had >1 car in household.
Interventions	For students: survey, home to school mapping exercise, preparation for high school For teachers: professional development, classroom learning materials, travel access guide for each school, launch of this guide at school Parents: parent survey, monthly newsletters, parent & citizen association meetings Council: review of safety and walkability near participating schools, working with councils to improve safety and walkability near these schools Duration of intervention: 19 months
Outcomes	Student‐reported travel mode each day for five days; parent‐reported usual travel mode to and from school. Effects on inequalities not reported. Adverse effects not reported.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	Low risk	Pulled out of a hat, alternating assignment
Allocation concealment?	Low risk	Pulled out of a hat, alternating assignment
Blinding?   All outcomes	High risk	Not feasible. Could have influenced outcomes
Incomplete outcome data addressed?   All outcomes	Low risk	Loss to follow‐up 35%, but those lost to follow‐up similar to other participants with respect to demographics, distance to school, baseline travel mode
Free of selective reporting?	Unclear risk	Not clear that all pre‐specified outcomes were included
Free of other bias?	Low risk	No other sources of bias identified
Adequate matching of intervention / control groups?	High risk	Despite randomisation, higher proportion of children lived <1km from intervention schools

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Characteristics of excluded studies [ordered by study ID]

Study	Reason for exclusion
ADONIS 2000	Not intervention research
Al‐Akhras 1997	No control group
Alexander 2005	Not a travel behaviour change intervention
American School 1980	Not intervention research
Appleyard 2003	Not intervention research
Balepur 1998	Cross‐sectional results only
Balzani 2003	Cross‐sectional study
Bamberg 1998	No control group
Bamberg 2001	No control group
Bamberg 2002	Not a travel behaviour change intervention
Bamberg 2003	No control group
Bamberg 2007	Review article
Baroni 1998	No relevant outcomes reported
Black 2001	Cross‐sectional study
Boarnet 2005	Cross‐sectional study
Bradshaw 2001	Not intervention research
Cackowski‐Campbell 2006	Not intervention research
Chen 1999	Not an organisational intervention
Collins 2005	Cross‐sectional study
Cooper 2003	Cross‐sectional study
Cooper 2005	Cross‐sectional study
Davies 2005	No control group
Davison 2008	Review article
Delaney 2003	Not a travel behaviour change intervention
DfT 2005	Not controlled before‐after studies as baseline measurements occurred some time after intervention start
Dickinson 2003	Cross‐sectional study
DiGuiseppi 1997	Not intervention research
Floerchinger‐Franks 2000	Not a travel behaviour change intervention
Fujii 2006	Review article
Futurist 1997	Irrelevant topic
Goodwin 1973	Not intervention research
Gordon‐Larsen 2007	Cross‐sectional study
Hanssen 1993	Not intervention research
Hwang 1992	Not organisational setting
International Walk 2001	Not intervention research
ITE Journal 2001	Not intervention research
ITE Journal 2003	Not intervention research
James 2002	Not organisational setting
Kearns 2003	Cross‐sectional study
Kingham 2007	Not intervention research
Lindstrom 2008	Cross‐sectional study
Lopez 2000	No control group
Mackett 2005	Not travel behaviour change intervention
McManus 2005	Cross‐sectional study
Mealey 1999	Not travel behaviour change intervention
Merom 2005	No control group
MOST 2001	Not intervention research
Oja 1991	Not organisational intervention (community‐based RCT)
Oja 1998	Not travel behaviour change intervention
Parker 2003	Not controlled before‐after study as baseline measurement occurred some time after intervention start
Rose 2007	No control group
Rosenberg 2006	Not travel behaviour change intervention
Rossi 2004	Cross‐sectional study
Senft 2005	No control group
Shannon 2006	Cross‐sectional study
Simpson 1999	Not intervention research
Stahlspets 2006	Insufficient available data, unable to contact authors
Staunton 2003	No control group
Stewart 1994	Cross‐sectional study
Taniguchi 2007	Not organisational setting
Taylor 1997	Not intervention research
Telfer 2006	Not organisational setting
Thogerson 2008	Not organisational setting
Titheridge 2006	Not intervention study
Toor 2003	Not intervention research
TRL 2003	Collection of abstracts only
TRL 2007	Collection of abstracts only
Turner 1997	Cross‐sectional study
van Hengel 1999	Not organisational setting
Vuori 1994	Includes a randomised controlled trial but is not a travel behaviour change intervention; also includes a travel behaviour change intervention but has no control group
Wen 2005	No control group

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Characteristics of ongoing studies [ordered by study ID]

Heelan 2004.

Trial name or title	Walking school bus approach to increase physical activity levels of elementary school children
Methods	Not known
Participants	Elementary school children
Interventions	Walking school bus
Outcomes	Not known
Starting date	Not known
Contact information	Kate Heelan, PhD   Associate Professor/Director   Human Performance Laboratory   Dept. HPERLS   University of Nebraska at Kearney   Kearney, NE 68849 USA   heelanka@unk.edu
Notes	Manuscript in preparation Abstract published as 'Walking school bus approach to increase physical activity levels of elementary school children. Heelan K, Boury S, Donnelly J. Obesity Research. 2004;12:A7‐A7'

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Differences between protocol and review

Contributions of authors

Conception and design: JH, AM, JC, CB, SA

Co‐ordination of review: JH, AM, SA

Data collection and data management: JH, AM

Analysis and interpretation: JH, AM

Drafting the review: JH, AM

Revising the review: JH, AM, JC, CB, SA

Declarations of interest

Jamie Hosking has received funding for a project investigating the potential health effects of school travel plans. Funders for this initiative included: the Energy Efficiency and Conservation Authority (New Zealand), which was involved in the implementation of school travel plans in New Zealand; and Land Transport New Zealand, which was involved in the funding of school travel plans in New Zealand. He is also involved in the steering group for the travel plan for his local school.

Alex Macmillan has received funding for a project using participatory methods to influence policy around commuting. Funders for this project include: the Health Research Council of New Zealand, the New Zealand Transport Agency and the New Zealand Ministry of Health. In 2008/9 she was a public health advisor on the Auckland Regional Land Transport Technical Advisory Committee. She helps co‐ordinate the Walking School Bus for her local primary school.

New

References

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PERMALINK

Organisational travel plans for improving health

Jamie Hosking

Alexandra Macmillan

Jennie Connor

Chris Bullen

Shanthi Ameratunga

Abstract

Background

Objectives

Search methods

Selection criteria

Data collection and analysis

Main results

Authors' conclusions

Plain language summary

Background

Description of the condition

Description of the intervention

How the intervention might work

Why it is important to do this review

Objectives

Methods

Criteria for considering studies for this review

Types of studies

Types of participants

Types of interventions

Types of outcome measures

Primary outcomes

Secondary outcomes

Search methods for identification of studies

Electronic searches

Searching other resources

Data collection and analysis

Selection of studies

Data extraction and management

Assessment of risk of bias in included studies

Data synthesis

Results

Description of studies

Results of the search

Included studies

Design

Settings

Participants

Interventions

Outcomes

Other study characteristics

Excluded studies

Risk of bias in included studies

1.

2.

Matching of intervention and control groups

Sequence generation

Allocation

Blinding

Incomplete outcome data

Selective reporting

Effects of interventions

Primary outcomes

Secondary outcomes

Discussion

Summary of main results

Overall completeness and applicability of evidence

Quality of the evidence

Potential biases in the review process

Agreements and disagreements with other studies or reviews

Authors' conclusions

Implications for practice.

Implications for research.

Acknowledgements

Appendices

Appendix 1. MEDLINE search strategy

Appendix 2. Websites searched

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Atherton 1982.

DfT 2005 Bracknell Forest.

DfT 2005 Lancashire.

DfT 2005 Redcar Cleveland.