Healthy People 2010 included increasing the percentage of children who walk to school as a national health priority.⁵ Research has demonstrated that walking to school among school-aged children is associated with higher levels of overall physical activity compared with children who travel to school by bus or car.⁶ Unfortunately, children spend less time in active transport than in decades past;⁴ this decline is greater for low socioeconomic areas.⁷ These declines may be related to concerns about safety, which are often cited as a barrier to physical activity among children and their parents.^7–10

Perceived and objective measures of neighborhood safety (related to traffic, environmental hazards, crime, and incivilities) have been associated with reduced levels of physical activity in many,^8–12 but not all studies.^13–16 Safety of parks and play areas has also been positively associated with increased physical activity levels,¹⁷ as has neighborhood aesthetics and tidiness.^18,19 Negative relationships have been documented between neighborhood area deprivation,²⁰ crime density,¹¹ urban residence,^21,22 and measures of social and physical disorder.¹²

Most studies of neighborhood safety and physical activity or walking behavior have assessed parent and child perception rather than objective risk.^8,14,19 Few studies to date have examined both perceived and objective measures of neighborhood safety as they pertain to outdoor physical activity among children, particularly among those in urban settings.

Following institutional review board approval, child assent and written informed consent was obtained from parents/caregivers. The MORE Project team recruited the first cohort in 2007, comprised of 427 children from the 3rd, 4th, and 5th grades in 6 urban public elementary schools located in 3 Baltimore, Maryland communities with low, moderate, and high levels of neighborhood crime. Three separate assessments were conducted to obtain information during interviews with children, teachers, and caregivers. All questions included in this substudy of the MORE Project were self-report.

Maps depicting the primary outcome (walking status) and the primary predictor of interest (level of incivilities) for participants attending a pair of schools can be seen in Figure 1. Locator maps highlight the location of the 2 schools in the context of the total study area.

Results suggest that level of incivilities is not a barrier to active transportation to school in this sample, in contrast to our hypothesis. Previous research in this area has demonstrated mixed findings. At least 3 studies have shown that rates of active transportation to school are higher in low-income areas as compared with higher-income areas.^31–33 Other research has shown higher levels of physical activity among youth who reside in neighborhoods with few incivilities and high levels of perceived safety. A study of a multiethnic sample of 1378 children and adolescents in Chicago examined resident perceptions of neighborhood safety and opportunities to play as well as objective measures of neighborhood social (eg, public intoxication, people selling drugs, gangs present) and physical disorder (eg, graffiti, abandoned cars, condoms, needles, empty beer bottles) in relation to caregiver report of youth physical activity levels.¹² In multilevel analyses, perceived neighborhood safety was positively associated with physical activity and neighborhood social disorder was negatively associated with physical activity, controlling for individual and community level age, sex, race, socioeconomic status, and body mass index.In the current study, by contrast, children residing on street blocks high in incivilities were more likely to walk to school. One possible explanation is that street blocks high in incivilities are those of particularly concentrated disadvantage. Four of the six schools from which the sample was obtained were Title 1 public schools, indicative of disadvantage. Children residing in these areas are likely to walk to and from school out of necessity, as their households do not have the resources (ie, cars, time, adults at home immediately before and after school) to drive or otherwise transport their children. While previous research has found that lack of perceived neighborhood safety is a barrier to active transportation,¹² perceived lack of safety was not associated with walking to school in this study. The finding that the children residing on street blocks high in incivilities were more likely to perceive their neighborhoods to be unsafe, but also more likely to walk to school provides support for the notion that children were walking to school out of necessity.

Another possible explanation is that neighborhoods with high levels of incivilities also demonstrate other characteristics that are positively associated with the likelihood of walking to school such as high levels of street-connectivity or the presence of sidewalks. As we did not include measures of aspects of the built environment in our analyses, we were unable to assess this possibility.

In addition, neighborhoods high in incivilities may also have high levels of residential density. If children live in closer proximity to each other, they may be more likely to walk to school as they have several other children to walk with. The majority of children in this study sample walked with either other children or with adults. Additional analyses looking at children who walked with others vs. all other modes of travel to school indicated that residing on a block above the median in incivilities was statistically significantly associated with a 2.28 factor increase in the odds of walking with others compared with other travel modalities (OR: 2.28; 95% CI: 1.31 to 3.98, P = .004). Children (or their parents or caregivers) may be more likely to walk with others if they live in an area with high levels of incivilities, due to safety concerns. Though we did not assess residential density, future directions include concurrently assessing the built and social environments and their relationship with walking to school.

There are limitations of this research that warrant discussion. First, the MORE project was not designed to primarily assess walking behavior, thus walking to school was assessed by only 1 question that has not been validated. While this approach was not ideal, the question used in the current study is similar to an item used in the National Household Transportation Survey inquiring about transportation to and from school, which has established validity.³⁴ Our use of self-reported walking is similar to other studies in the extant literature that have described associations between self-reported walking to school and physical activity levels among children.^35,36 Additionally, previous studies of self-reported daily travel surveys among elementary school-aged children have reported good test-retest reliability and criterion validity compared with parental report.^37,38

Second, we did not have information on other potential confounders including household car ownership. Variables such as car ownership or bus availability may be an important factor in explaining why children residing on blocks high in incivilities may be more likely to walk to school, as individuals residing on blocks high in incivilities may be less likely to own a car, or less likely to have ready access to school buses or other types of public transportation. This limitation notwithstanding, the finding that a high proportion of children are walking to school despite the presence of numerous neighborhood incivilities or hazards is important for public safety efforts, regardless of the underlying causal pathway.

Third, the extent to which results might generalize to other locations that have lower levels of neighborhood incivilities and hazards is unknown. However, these results are likely generalizable to other urban environments with a similar sociodemographic composition and measures of neighborhood incivilities and hazards. Fourth, straight-line distance between home and school was used as we did not have data on the exact paths by which children traveled to and from school. An alternate approach would have been to use the shortest distance along streets. However, children may not take the shortest path along roads, they may take different paths according to whether they are walking with other children, whether there are ‘short-cuts’ through alleys or parks, or whether they prefer to walk along major roads. To avoid making the assumption that children always take the shortest path along streets, we decided to use the simpler measure of straight-line distance as opposed to ‘walking distance’ along roads. Future studies in this area would benefit from obtaining data on actual paths traveled to school.

Finally, the 2000 Census data were collected several years before NIfETy or MORE project data. Measurement error may therefore have been introduced as a consequence of changes in neighborhood sociodemographic characteristics over time. If this bias was introduced, we believed that it would have been nondifferential and thus underestimated the true impact of sociodemographic factors on the odds of walking to school.