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Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCHbest. NPM 7: Injury Hospitilization

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Strategy. Modification of Infrastructure to Enhance Pedestrian Safety

Approach. Modify the infrastructure around schools by installing new traffic and pedestrian signals; adding exclusive pedestrian crossing times; installing speed bumps, speed boards, and high-visibility crosswalks; and enforcing new parking regulations.

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Overview. Studies show that modifying the physical environment around schools to make it safer for pedestrians is the most effective way to prevent child pedestrian injuries. These modifications can include installation of new traffic and pedestrian signals, addition of exclusive pedestrian crossing times, installation of speed bumps, speed boards (radar-equipped digital signs that tell drivers how fast they are moving), and high-visibility crosswalks, and enforcement of new parking regulations.1

Evidence. Moderate/Emerging. Programs that implement modifications to the physical environment around schools appear to be effective in reducing child pedestrian injuries. Programs based on this strategy are likely to work. This strategy has been tested more than once and results trend positive overall. Access the peer-reviewed evidence through the MCH Digital Library. (Read more about understanding evidence ratings).

Target Audience. Communities and their schools.

Outcome. Reduction of school-age pedestrian injury. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the "Intervention Results" for each study.

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM. You may also want to look at evidence that supports educational programs in other NPM topic areas that can be translated to this specific topic area.

Sample ESMs. Using the approach “Modify the infrastructure around schools by installing new traffic and pedestrian signals; adding exclusive pedestrian crossing times; installing speed bumps, speed boards, and high-visibility crosswalks; and enforcing new parking regulations,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework:

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of schools and communities participating in infrastructure modification program.
  • Number of schools and communities offering infrastructure modification programs to prevent child pedestrian injuries.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of schools and communities participating in infrastructure modification program.
  • Percent of schools and communities offering infrastructure modification programs to prevent child pedestrian injuries.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of schools and communities participating in infrastructure modification program that showed a reduction in school-age pedestrian injury.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of schools and communities participating in infrastructure modification programs that showed a reduction in school-age pedestrian injury.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4).

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


References:

1 DiMaggio C, Li G. Effectiveness of a safe routes to school program in preventing school-aged pedestrian injury. Pediatrics 2013;131: 290-6. 

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.