Active travel (such as walking, cycling and scooting) has a range of benefits for human and planetary health, whereas driving children to school contributes substantially to motor vehicle traffic at peak times. Local governments have collaborated with schools to implement traffic restriction schemes, in which motor vehicle access around schools is restricted at drop-off and pick-up times. We examined the impacts of these schemes on how children travel to school, and how these differed between socio-economic groups, in England and Scotland. In this controlled before-and-after natural experimental study, we used data collected by primary schools on children’s mode of travel to school between 2012 and 2023. We matched each intervention school to two control schools based on area-level deprivation, urban–rural status, school size, baseline prevalence of active travel to school, and geographical region. We used fixed-effects regression models to conduct difference-in-difference analyses of the percentage of pupils using active modes of transport and private motor vehicles, adjusting for potential confounding factors. We examined absolute and relative differences and differential effects by stratifying analyses by geographical region, method of enforcement, area-level deprivation, and urban–rural status. We used data from 498 schools (166 intervention and 332 control) at which on average 70

BackgroundIn 2016, large-scale 20 miles per hour speed limits were introduced in the United Kingdom cities of Edinburgh and Belfast. This paper investigates the role that scientific evidence played in the policy decisions to implement lower speed limits in the two cities.MethodsUsing a qualitative case study design, we undertook content analysis of a range of documents to explore and describe the evolution of the two schemes and the ways in which evidence informed decision-making. In total, we identified 16 documents for Edinburgh, published between 2006 and 2016, and 19 documents for Belfast, published between 2002 and 2016.FindingsIn both cities, evidence on speed, collisions and casualties was important for initiating discussions on large-scale 20 mph policies. However, the narrative shifted over time to the idea that 20 mph would contribute to a wider range of aspirations, none of which were firmly grounded in evidence, but may have helped to neutralize opposing discourses.Discussion and conclusionsThe relationship between evidence and decision-making in Edinburgh and Belfast was neither simple nor linear. Widening of the narrative appears to have helped to frame the idea in such a way that it had broad acceptability, without which there would have been no implementation, and probably a lot more push back from vested interests and communities than there was.

Background: A recent meta-narrative review investigating 20mph speed limits on public health outcomes reported inconclusive findings and the limited scope of liveability investigations. Consequently, we investigated the impact of 20mph speed limit interventions on liveability using the Microscale Audit of Pedestrian Streetscapes Liveability (MAPS-Liveability) via Google Street View (GSV). Methods: MAPS-Liveability provides a quantitative assessment of liveability and its constructs (i. e., safety, health, sustainability, inclusivity, places, education, traffic/transport, roads, and pavements) at the micro-level (i.e., street). Google Street View enabled pre- and postimplementation data collection for Belfast (n = 68 streets) and Edinburgh (n = 76 streets) by two independent raters, with scores calculated for total liveability and nine liveability constructs. Wilcoxon signed-rank tests (changes pre-to post-implementation), cluster analysis (identification of discrete street clusters), analysis of variance (differences within clusters) and analysis of covariance (differences between clusters) were undertaken. Clusters were mapped, street types identified, and clusters named by determining the predominant street type. Results: In Belfast and Edinburgh, there were significant increases post-intervention for total liveability, with 57.4% (n = 39) of streets in Belfast and 75% (n = 57) in Edinburgh seeing positive changes. Both cities also saw significant positive increases in the liveability constructs of traffic/transport (e.g., speed signage) and places (e.g., presence of shops); with Edinburgh also seeing a significant positive increase post -intervention for pavements (e.g., quality). Cluster analysis identified three clusters "Mixed land use ", "Central Business District " , "Residential " with each showing positive changes for total liveability and the construct of traffic/transport. Conclusion: 20mph speed limit interventions were found to positively contribute to total live- ability and the specific liveability construct of traffic/transport. This was particularly the case when 20mph speed limits were implemented on streets with dense mixed land use.

Background: Transport initiatives such as 20-mph (≈30-km/h) speed limits are anticipated to result in fewer road casualties and improve perceptions of safety, leading to increases in active travel. Lower speeds may also lead to more pleasant environments in which to live, work and play. Objectives: The main objective was to evaluate and understand the processes and effects of developing and implementing 20-mph speed limits in Edinburgh and Belfast. The focus was on health-related outcomes (casualties and active travel) that may lead to public health improvements. An additional objective was to investigate the political and policy factors (conditions) that led to the decision to introduce the new speed limits. Design: This was a mixed-methods study that comprised an outcome, process, policy and economic evaluation of two natural experiments. Setting: The study was set in Edinburgh, Scotland, and Belfast, Northern Ireland, from 2000 to 2018. Participants: The whole population of each city were participants, as well as stakeholders involved in implementation and decision-making processes. Intervention: The intervention was the implementation of 20-mph legislation, signage, enforcement, and education and awareness-raising in Edinburgh (citywide) and Belfast (city centre). Main outcome measures: The main outcomes measured were speed; number, type and severity of road collisions; perceptions; and liveability. Data sources: The following data sources were used – routinely and locally collected quantitative data for speed, volume of traffic, casualties and collisions, and costs; documents and print media; surveys; interviews and focus groups; and Google Street View (Google Inc., Mountain View, CA, USA). Results: Collisions and casualties – the overall percentage reduction in casualty rates was 39% (the overall percentage reduction in collision rates was 40%) in Edinburgh. The percentage reduction for each level of severity was 23% for fatal casualties, 33% for serious casualties and 37% for minor casualties. In Belfast there was a 2% reduction in casualties, reflecting differences in the size, reach and implementation of the two schemes. Perceptions – in Edinburgh there was an increase in two factors (support for 20 mph and rule-following after implementation) supported by the qualitative data. Liveability – for both cities, there was a small statistical increase in liveability. Speed – mean and median speeds reduced by 1.34 mph and 0.47 mph, respectively, at 12 months in Edinburgh, with no statistically significant changes in Belfast. History, political context, local policy goals, local priorities and leadership influenced decision-making and implementation in the two cities. Limitations: There was no analysis of active travel outcomes because the available data were not suitable. Conclusions: The pre-implementation period is important. It helps frame public and political attitudes. The scale of implementation and additional activities in the two cities had a bearing on the impacts. The citywide approach adopted by Edinburgh was effective in reducing speeds and positively affected a range of public health outcomes. The city-centre approach in Belfast (where speeds were already low) was less effective. However, the main outcome of these schemes was a reduction in road casualties at all levels of severity. Future work: Future work should develop a statistical approach to public health interventions that incorporates variables from multiple outcomes. In this study, each outcome was analysed independently of each other. Furthermore, population measures of active travel that can be administered simply, inexpensively and at scale should be developed. Study registration: This study is registered as ISRCTN10200526. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 9. See the NIHR Journals Library website for further project information.

Objectives Traffic speed is important to public health as it is a major contributory factor to collision risk and casualty severity. 20mph (32km/h) speed limit interventions are an increasingly common approach to address this transport and health challenge, but a more developed evidence base is needed to understand their effects. This study describes the changes in traffic speed and traffic volume in the City of Edinburgh, pre- and 12 months post-implementation of phased city-wide 20mph speed limits from 2016–2018. Methods The City of Edinburgh Council collected speed and volume data across one full week (24 hours a day) pre- and post-20mph speed limits for 66 streets. The pre- and post-speed limit intervention data were compared using measures of central tendency, dispersion, and basic t-tests. The changes were assessed at different aggregations and evaluated for statistical significance (alpha = 0.05). A mixed effects model was used to model speed reduction, in the presence of key variables such as baseline traffic speed and time of day. Results City-wide, a statistically significant reduction in mean speed of 1.34mph (95% CI 0.95 to 1.72) was observed at 12 months post-implementation, representing a 5.7% reduction. Reductions in speed were observed throughout the day and across the week, and larger reductions in speed were observed on roads with higher initial speeds. Mean 7-day volume of traffic was found to be lower by 86 vehicles (95% CI: -112 to 286) representing a reduction of 2.4% across the city of Edinburgh (p = 0.39) but with the direction of effect uncertain. Conclusions The implementation of the city-wide 20mph speed limit intervention was associated with meaningful reductions in traffic speeds but not volume. The reduction observed in road traffic speed may act as a mechanism to lessen the frequency and severity of collisions and casualties, increase road safety, and improve liveability.

Background: Liveability is a complex, multifaceted concept with various definitions, but with an agreed core set of features (e.g., safety, walkability).Typically, liveability is measured at the macro-level (city or regional-level), and has been used in advocacy by local populations.However, micro-level (street-level) liveability measurements could also/alternatively be used to identify modifiable environmental features impacting health and well-being.To date, no micro-level liveability tools exist.This study investigates the reliability and rater agreement of a new micro-level audit tool designed for use with Google Street View (GSV).Methods: MAPS-Liveability (GSV), was adapted from the Microscale Audit of Pedestrian Streetscapes (MAPS).This study had two phases: 1) MAPS-Liveability development (rapid literature review identifying core liveability concepts, focus groups confirming liveability concepts and tool adaptation); 2) reliability investigation (researcher agreement).Assessment was made of: total liveability; nine liveability subcharacteristics (e.g., safety, health); and 12 proxy measures of behaviour including active travel (e.g., bicycle racks, presence of bicycles in racks).Inter-rater reliability and sensitivity to change were assessed by percentage agreement, inter-class correlation coefficients (ICC) and Wilcoxon signed-ranked tests (p<0.05).Results: Inter-rater reliability was excellent (ICC 0.905-0.968)for total liveability, parked cars and total number of cars (moving/parked); good (ICC 0.754-0.885)for health, sustainability, places, number of bicycle racks, bicycle rack capacity, number of bicycles in the racks (time-point 2), cyclists (time-point 2), moving cars (time-point 2) and pedestrians; and moderate (ICC 0.550-0.742)for safety, inclusivity, education, traffic/transport, pavements, roads, cyclists (time-point 1), number of bicycles in the racks (time-point 1) and moving cars (time-point 1). Conclusion:MAPS-Liveability provides a reliable assessment of micro-level liveability features.MAPS-Liveability has excellent inter-rater reliability for total liveability and moderate-excellent inter-rater reliability for liveability attributes and behavioural indicators.GSV at street-level supports safe, large-scale objective data collection, and collection of historical data where primary data is unavailable.

INTRODUCTION:Reductions in traffic speed can potentially offer multiple health and public health benefits. In 2016, implementation of 20mph (30kph) speed limit interventions began in Edinburgh (city-wide) and Belfast (city centre). The aims of this paper are to describe 1) the broad theoretical approach and design of two natural experimental studies to evaluate the 20mph speed limits in Edinburgh and Belfast and 2) how these studies allowed us to test and explore theoretical mechanisms of 20mph speed limit interventions. METHODS:The evaluation consisted of several work packages, each with different research foci, including the political decision-making processes that led to the schemes, their implementation processes, outcomes (including traffic speed, perceptions of safety, and casualties) and cost effectiveness. We used a combination of routinely and locally collected quantitative data and primary quantitative and qualitative data. RESULTS:The evaluation identified many contextual factors influencing the likelihood of 20mph speed limits reaching the political agenda. There were substantial differences between the two sites in several aspects related to implementation. Reductions in speed resulted in significant reductions in collisions and casualties, particularly in Edinburgh, which had higher average speed at baseline. The monetary value of collisions and casualties prevented are likely to exceed the costs of the intervention and thus the overall balance of costs and benefits is likely to be favourable. CONCLUSIONS:Innovative study designs, including natural experiments, are important for assessing the impact of 'real world' public health interventions. Using multiple methods, this project enabled a deeper understanding of not only the effects of the intervention but the factors that explain how and why the intervention and the effects did or did not occur. Importantly it has shown that 20mph speed limits can lead to reductions in speed, collisions and casualties, and are therefore an effective public health intervention.

Introduction: High quality evaluations of new walking and cycling routes are scarce and understanding contextual mechanisms influencing outcomes is limited. Using different types of data we investigate how context is associated with change in use of new and upgraded walking and cycling infrastructure, and the association between infrastructure use and overall physical activity. Methods: We conducted repeat cross-sectional pre-post analysis of monitoring data from a variety of walking and cycling routes built in 84 locations across the United Kingdom (the Connect2 programme, 2009?2013), using four-day user counts (pre n = 189,250; post n = 319,531), nextto-pass surveys of route users (pre n = 15,641; post n = 20,253), and automatic counter data that generated estimates of total annual users. Using multivariable logistic regression, we identified contextual features associated with 50% increase and doubling of pedestrians, cyclists, and subgroups of users. We combined insights from monitoring data with longitudinal cohort data (the iConnect study) from residents living near three Connect2 schemes. Residents were surveyed by post at baseline, one-year (n = 1853) and two-year follow-up (n = 1524) to investigate associations between use of the new infrastructure and meeting physical activity guidelines. Results: The routes were associated with increased use (median increase in cyclists 52%, pedestrians 38%; p < 0.001). Large relative increases were associated with low baseline levels (e.g. odds of doubling cycling were halved for each additional 10,000 annual cyclists at baseline: OR 0.52, 95% CI 0.31, 0.77). Use was associated with meeting physical activity guidelines in both repeat cross-sectional and longitudinal analyses (users vs. non-users after one year, OR 2.07, 95% CI 1.37, 3.21; after two years, OR 2.00, 95% CI 1.37, 2.96). Conclusions: This examination of use, users, benefit-cost ratios, and physical activity associated with new walking and cycling infrastructure across contexts, using multiple types of data, suggests that building walking and cycling infrastructure could improve population health and reduce inequalities.

The Health Foundation commissioned Sustrans and the University of the West of England to ‘assess the role of transport in supporting young people to develop and transition to an independent healthy future’. This report focuses on the transport available to young people and how it’s functioning can shape the long-term health of young people today. The report makes seven policy and research recommendations based on the review of existing literature and analysis of how transport can affect young people’s development and future prospects.

This paper describes an economic evaluation of the first phase of the English Cycling Demonstration Town investment program, which has an estimated cost of £18 million over three years. The economic evaluation uses monitoring data and applies both the WebTAG framework and the World Health Organization’s HEAT for cycling tool in novel contexts. The results of the Cycling Demonstration Town program are summarized, and the assumptions made and data inputs used are described. The paper reveals a benefit to cost in the range 2.6-3.5:1. The extent to which this may be a conservative estimate, and how improvements can be made to future exercises are also discussed in the paper.

The National Cycle Network (NCN) in the U.K. has increased opportunities for people to make trips by bicycle and on foot. In this article, data from the NCN route usage monitoring project is analyzed to examine implications of the NCN for health, social inclusion, economic opportunities through tourism and recreation, and the nature of cyclists and cycling. Analysis of survey data suggests that various benefits are being realized. The capacity of NCN to further impact in these and other areas is discussed.