This study systematically reviewed the available literature on interventions involving changes to the urban built environment and reported health-related behaviors or outcomes for children and youth. A comprehensive search of six databases yielded 33 relevant primary studies relating to 27 separate urban environment interventions. Four tables are included in the report: (1) a summary of included primary studies; (2) the characteristics of study designs; (3) an assessment of bias in primary studies; and (4) a summary of results and risk of bias for included studies.
Fifteen of the studies focused on changes to promote active travel; eight interventions involved modifications to parks and playgrounds; three studies focused on changes to road traffic safety measures; and seven studies focused on multi-component, community-based initiatives.
The “active travel” interventions included modifications designed to make it safer for students to walk or bike to school. While thirteen of the fifteen “active travel” studies suggested an increase in active travel, the authors indicate that the findings need to be treated with caution as the overall risk of bias was rated as serious.
The overall risk of bias was rated as serious for the “parks and playgrounds” studies, as well. Additionally, while two of the studies indicated an increase in the number of children and teens using the parks after modifications, two studies showed a decline in the number of park users. Results also indicated that the interventions did not seem to increase children's or teens' level of physical activity.
Of the three “road safety” studies, two showed a decline in injury and casualties, while one showed a non-significant reduction in collisions involving pedestrians/bicyclists. The overall risk of bias in these studies was considered moderate.
Of the seven studies in the “multi-component community-based initiatives” category, three were judged to have an overall moderate risk of bias, with the other four being rated as serious.
Overall, the studies in this review provide some evidence of effectiveness in reducing road traffic injuries and increasing young people's active travel to school. There was also some evidence of effectiveness in obesity prevention. While increased usage or physical activity levels were not found with modifications to public playgrounds and parks, other review studies have indicated that modifications to playgrounds at schools do promote a higher level of physical activity. Additionally, other reviews have suggested that combining changes to the built environment with physical activity programs could be more effective than changes to the built environment alone.
Although the studies included in this review are judged to be at moderate or serious risk of bias, the researchers recognize that postponing action until a strong evidence base is in place may cause more harm than good. They, therefore, suggest that public health researchers, policy makers, and the public sector work collaboratively to implement and evaluate interventions focusing on healthy urban environments for children and youth.
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