Public Health Involvement in United States' Vision Zero Initiatives: A Mixed-Methods Study.

CONTEXT: Vision Zero (VZ) aims to reduce fatalities and serious injuries from road traffic crashes to zero through multidisciplinary coordination. While public health officials are often recognized as critical to VZ, their involvement in VZ across the United States has not been quantified. OBJECTIVE: To explore how United States public health officials were involved in VZ development and implementation. DESIGN: We used a mixed-method design including a quantitative assessment of VZ plans and in-depth interviewing with VZ coordinators. SETTING: United States. PARTICIPANTS: Twenty-two in-depth interviews with municipal (n = 12) and regional (n = 10) VZ coordinators and 43 VZ plans were reviewed. MAIN OUTCOME MEASURE: Public health involvement in VZ development and implementation. RESULTS: In the United States, 64 municipalities and 21 regional entities had first-time VZ plans published between 2014 and 2022. We abstracted a sample of municipal (n = 22) and all (n = 21) regional plans. Most plans described key groups involved in plan development (municipal 81.8%, regional 100%). About two-thirds (67.4%; 59.1% municipal, 76.2% regional) of the plans noted public health officials in the plan development. Most plans described the principles forming the foundation of their plan (83.7%), but few mentioned public health as part of the plan principles (22.7% municipal, 14.3% regional). Public health officials were involved in engaging the community (9.1% municipal, 33.3% regional) and providing data (22.7% municipal, 52.4% regional) for plan development, as documented in the plans. For proposed implementation, public health officials were identified as involved in: community engagement (31.8% municipal, 42.9% regional), sharing/analyzing data (40.9% municipal, 33.3% regional), and identifying/providing funding sources (13.6% municipal, 4.8% regional). The in-depth interviews provided further context and a more detailed understanding of public health involvement in VZ. CONCLUSIONS: Evidence from the VZ plans and interviews provided examples of how public health officials engaged in the development and implementation of VZ initiatives.

Mixed-methods approach to describing Vision Zero initiatives in United States' municipalities.

Vision Zero (VZ) aims to reduce fatalities and serious injuries from road traffic crashes to zero through a Safe Systems approach. Little is known about the extent of uptake of VZ in the United States (US), or the attributes and functioning of the initiatives. Using a mixed-methods design, our objectives were to describe the status of VZ implementation and characteristics of those initiatives among US municipalities. Websites of all US municipalities with a population of at least 50,000 (n = 788) were searched to identify involvement in VZ. When initiatives were identified, we abstracted information from their website and other published documents, using a comprehensive framework of best practice VZ components. From the VZ initiatives identified, we interviewed representatives from 12 municipalities with diversity by region of the country, population size, and VZ implementation. Interviews were recorded, transcribed, and coded for themes. Through systematic web-based searching, we identified 86 of 788 (10.9%) municipalities with a VZ initiative. Among 314 larger municipalities (population >=100,000), 68 (21.7%) were identified. Among 476 medium-size municipalities (population of 50,000-99,999), 18 (3.8%) were identified. VZ initiatives began as early as 2014, starting with larger municipalities, and followed in 2015 with medium-size municipalities. Among the VZ initiatives, 58 (67.4%) recorded a vision statement, with 51 (59.3%) setting a target year to reach zero deaths. Thirty-nine (45.3%) had published VZ plans, with another 22 (25.6%) working towards a plan. Twenty-five initiatives (29.1%) shared resources across stakeholder groups, such as funding or staff. Forty-six initiatives (53.5%) had an established coalition, and 18 (20.9%) proposed or were developing a coalition. Twenty-six initiatives (30.2%) provided regular updates or evaluation on progress towards performance metrics, but only 4 (4.7%) had implemented a performance management system to regularly track progress on VZ-related actions. The interviews provided further context and a more detailed understanding of results. Documenting the characteristics of VZ initiatives among US municipalities can contribute to an understanding of current practice, potential opportunities to support ongoing initiatives, and information to assist new initiatives. Ultimately, the impact of municipal-level VZ efforts should be evaluated with regards to traffic-related serious injuries and fatalities.

Mixed method assessment of built environment and policy responses to the COVID-19 pandemic by United States municipalities focusing on walking and bicycling actions.

Introduction: In 2020, the COVID-19 pandemic prompted community officials to initiate local level environmental and policy changes to slow the spread of infection and provide more opportunities for outdoor recreation. Changes in both regards could positively or negatively impact walking and bicycling. Using a mixed methods approach, the purpose of this United States-based study was to systematically describe municipal response to the pandemic at the community level through environmental and policy changes that may have impacted walking and bicycling. Methods: Websites of all United States' municipalities with a residential population of at least 100,000 (n = 314) were searched to identify environmental and policy changes that might impact walking/bicycling as a result of the pandemic. When actions were identified, we systematically abstracted information from the websites. To provide more contextual information, we interviewed representatives from 12 municipalities about changes made at the municipal level as a result of the pandemic that could impact walking and bicycling. Interviews were recorded, transcribed, and coded for themes. Results: For the 314 municipalities, we identified 353 actions resulting from the COVID-19 pandemic that may impact walking and bicycling. Approximately double the number of actions were identified in large-size municipalities (234 actions in 157 municipalities with population≥165,000) compared to mid-size municipalities (119 actions among 157 municipalities with population 100,000 to 164,999). Generally, fewer actions that might suppress walking and bicycling (n = 59) were identified in comparison to actions that would likely facilitate walking and bicycling (n = 294). In-depth interviews provided further context and insight into these results. Conclusion: This mixed-method assessment provides an overview of the environmental and policy changes which may impact walking and bicycling that municipalities implemented in 2020 due to the pandemic. A next step in this line of inquiry is to quantify the impact of these changes on population levels of walking and bicycling and related health and safety outcomes.

U.S. active school travel in 2017: Prevalence and correlates.

Active transportation to school (ATS), denoting walking and biking, is crucial to promote physical activity for youth. This study uses data from the 2017 National Household Travel Survey (NHTS) to report on the most recent and nationally representative school transportation patterns. Binary logit modeling determines significant factors associated with school travel mode choices. Spatial differences on school mode choices across the US are explored. In 2017 9.6% of the students of 5-17 years old usually walked and 1.1% biked to school. For students who usually walk to school, 77.5% of their school trips were less than one mile and, among usual bikers to school, 82.8% of trips were less than two miles. Student rates of walking to school decreased as the distance to school increased and biking rates peaked when distance to school was between 0.5 and 1 miles. When distance to school was <0.5 miles, walking was the most common mode for urban and rural regions. When the trip was shorter than or equal to one mile, factors such child's school grade, household vehicles per driver, and household income were associated with the decision to walk or bike to school. Other demographic characteristics like race and gender were not significantly related to ATS. While comparison across NHTS years should be viewed with caution due to changes in survey methodology, the decline of ATS rates indicate that more effective and higher reaching efforts for local, regional, and national interventions should be prioritized.

Systems thinking in the context of road safety: Can systems tools help us realize a true "Safe Systems" approach?

PURPOSE OF REVIEW: Road traffic injuries are one of the leading causes of death in the U.S. and globally. We introduce the Safe Systems approach as a promising paradigm for road safety practice and describe how systems thinking tools can help bridge the gap between the current status quo and a Safe Systems approach. RECENT FINDINGS: Systems thinking tools can help us align with a Safe Systems approach by identifying latent risks in the transportation system, examining factors that coalesce to produce high travel speeds and kinetic energy transfer, and supporting safety prioritization through goal alignment. SUMMARY: The Safe Systems approach represents a significant change in the way we have historically designed transportation systems; it puts safety at the forefront and calls for designing a system that accounts for human fallibility. Operationalizing holistic Safe Systems concepts may be difficult, but systems thinking tools can help. Systems thinking tools provide a common language for individuals from diverse disciplines and sectors to express their unique understanding of the interconnected factors shaping road safety problems and support discussions about potential solutions that align with a Safe Systems approach.

Diverse school community engagement with the North Carolina active routes to school project: a diffusion study.

BACKGROUND: Schools located in rural parts of the United States and North Carolina have benefited proportionally less from the federal Safe Routes to School (SRTS) program than their more urban counterparts. We investigated whether and how diverse elementary and middle school communities throughout North Carolina have engaged in a SRTS-inspired, multi-sectoral initiative called the Active Routes to School (ARTS) project over the course of 5 years (2013 through 2017). METHODS: Analyses included a study sample of 2602 elementary and middle schools in North Carolina, 853 that participated in the ARTS project over the five-year study period and 1749 that had not. Statistical models controlling for county- and school-level confounders predicted schools' involvement in walking and bicycling-promotive events, programs, and policies over time. RESULTS: Schools' engagement with ARTS Project programming increased significantly over the study period, with 33% of eligible schools participating with the project by the end of 2017. Participation was most common in promotional events. Such event participation predicted engagement with regularly recurring programming and school- and district-level establishment of biking- and walking-facilitative policies. Lower income schools were more likely to establish recurring bike and walk programs than wealthier schools, whereas rural schools were less likely than city schools to participate in promotional events, yet equally as likely as other schools to participate in recurring bike and walk programs. CONCLUSIONS: Schools' engagement with the North Carolina ARTS Project diffused despite many schools' rural geographies and lower socioeconomic status. Further, participation in one-time promotional events can portend schools' establishment of recurring walking and biking programs and supportive policies.

Organizational networks in road safety: Case studies of U.S. Vision Zero cities.

Objective: Each year, more than 30,000 deaths occur on U.S. roads. Recognizing the magnitude and persistence of this public health problem, a number of U.S. cities have adopted a relatively new approach to prevention, termed Vision Zero (VZ). VZ has been adopted by more than 30 U.S. cities and calls for creating a transportation system that ensures that no road traffic crash results in death or serious injury. A core component of VZ is strong multidisciplinary and multisector stakeholder engagement, and cities adopting VZ often establish a VZ coalition to foster stakeholder collaboration. However, there is little information on the structure, development, and functioning of coalitions working to achieve VZ and on tools available to study and evaluate such coalition functioning. We sought to describe the characteristics of prominent U.S. VZ city coalitions and context surrounding VZ uptake and advancement in these cities. Moreover, we demonstrate use of network analysis as one tool for exploring the structure of interorganizational relationships in coalitions. Methods: We conducted case studies of 4 prominent U.S. VZ city coalitions in 2017-2018. We summarized coalition members' characteristics and responses to questions about their cities' VZ adoption, planning, and implementation. We asked each coalition member to provide information on their contact frequency, perceived productivity, and resource sharing with every other coalition member in their city and used network analysis techniques in 2 cities to understand the structures and relationships in coalitions. Results: Findings indicated that government agencies generally constituted the majority of coalition members and often played central roles in terms of coalition network contact, productivity, and resource flow. Other emerging similarities regarding coalition establishment and VZ implementation included the need for political support, the importance of formal plan development, and increased collaboration and cooperation among partners. Conclusions: Organizational network analyses, enriched with coalition member interviews, can elucidate key aspects of coalition creation, attributes, and relationship structure. The case studies of leading VZ coalition networks presented here highlight the use of these tools. Ultimately, understanding associations between VZ network structures and attributes and road safety outcomes could help inform effective coalition adoption, implementation, and maintenance to optimize safety outcomes.

Awareness of Vision Zero among United States' road safety professionals.

BACKGROUND: Vision Zero is a strategy to eliminate all fatalities and serious injuries from road traffic crashes, while increasing safe and equitable mobility for all. In 2015, the United States' Department of Transportation announced the official target of the federal government transportation safety policy was zero deaths. In 2017, we assessed the dissemination of Vision Zero in the United States. METHODS: We conducted a web-based survey in 2017 among road safety professionals. Email invitations were sent using relevant membership directories and conference lists. RESULTS: We surveyed 192 road safety professionals, including planning/engineering (57.8%), public health (16.7%), and law enforcement/emergency medical services (EMS) (8.9%). Awareness of Vision Zero was higher among planning/engineering fields (97.3%) compared to law enforcement/EMS (76.5%) and public health (75.0%). Awareness was similar by number of years working in the field. Awareness was higher in the South (95.9%) and Northeast (95.0%) regions, followed by the West (90.8%) and Midwest (85.2%) Census regions. Among those that heard of Vision Zero (n = 174), 41.8% worked at a municipality with a Vision Zero campaign, while 41.2% did not. Among those working at a municipality with a Vision Zero campaign (n = 71), about half participated in the campaign (54.9%) while the other half did not (45.1%). CONCLUSIONS: With widespread dissemination of the Vision Zero strategy to road safety professionals, next steps include evaluating how Vision Zero is being adopted, implemented, and maintained in communities, as well as the awareness and acceptability by community members, and to identify the most promising policies and practices.

Diffusing innovative road safety practice: A social network approach to identifying opinion leading U.S. cities.

OBJECTIVE: This study sought to identify opinion-leading U.S. cities in the realm of safe transportation systems by surveying road safety professionals and asking them to identify places that served as models for road safety. METHODS: Using a purposive sampling methodology, we surveyed professionals employed in road safety-related professions (e.g., transportation engineering, planning, public health, law enforcement, and emergency response). Using 183 professionals' complete responses, we carried out social network analysis to both describe the structure of intermunicipal advice-seeking patterns among road safety professionals and identify those municipalities with relatively high degrees of influence. RESULTS: We discovered a large intermunicipal monitoring network related to improving road user safety. Half of the network ties (50.4%) crossed regional U.S. census boundaries. Social network statistics informed the identification of 7 opinion-leader and 4 boundary-spanning municipalities. CONCLUSIONS: This study indicated a large intermunicipal monitoring network, half of which crossed regional boundaries. Road safety professionals have formed a country-spanning example-following network on the topic of improving road user safety in the United States. Researchers and intervention teams can tap into this network to accelerate the uptake and spread of evidence-based road safety practices.