Background Literature focusing on youth has reported limited evidence and non-conclusive associations between neighborhood walkability measures and active commuting to and from school (ACS). Moreover, there is a lack of studies evaluating both macro- and micro-scale environmental factors of the neighborhood when ACS is analyzed. Likewise, most studies on built environment attributes and ACS focus on urban areas, whereas there is a lack of studies analyzing rural residential locations. Moreover, the relationship between built environment attributes and ACS may differ in children and adolescents. Hence, this study aimed to develop walkability indexes in relation to ACS for urban and rural children and adolescents, including both macro- and micro-scale school-neighborhood factors. Methods A cross-sectional study of 4593 participants from Spain with a mean age of 12.2 (SD 3.6) years was carried out. Macro-scale environmental factors were evaluated using geographic information system data, and micro-scale factors were measured using observational procedures. Socio-demographic characteristics and ACS were assessed with a questionnaire. Several linear regression models were conducted, including all the possible combinations of six or less built environment factors in order to find the best walkability index. Results Analyses showed that intersection density, number of four-way intersections, and residential density were positively related to ACS in urban participants, but negatively in rural participants. In rural children, positive streetscape characteristics, number of regulated crossings, traffic calming features, traffic lanes, and parking street buffers were also negatively related to ACS. In urban participants, other different factors were positively related to ACS: number of regulated crossings, positive streetscape characteristics, or crossing quality. Land use mix acted as a positive predictor only in urban adolescents. Distance to the school was a negative predictor on all the walkability indexes. However, aesthetic and social characteristics were not included in any of the indexes. Conclusions Interventions focusing on improving built environments to increase ACS behavior need to have a better understanding of the walkability components that are specifically relevant to urban or rural samples.

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This manuscript describes the rationale and protocol of a school-based randomized controlled trial called “Cycling and Walk to School” (PACO, by its Spanish acronym) that aims to promote cycling to and from school and physical activity (PA) in adolescents. This study will examine the effects of this intervention in cycling and active commuting to and from school (ACS), PA and several ACS-related factors based on self-determination theory (SDT) and a social-ecological model (SEM). A total of 360 adolescents attending six high schools (three experimental and three control) from three Spanish cities will participate in this randomized controlled trial. The intervention (four cycling sessions; 1–2 h per session, one session per week) will be conducted by the research staff; the control group will continue their usual activities. PA levels will be measured by accelerometers, whereas ACS and the other study variables will be self-reported using questionnaires at baseline and post-intervention. The primary outcomes will be: rates of cycling to school, ACS and PA levels. In addition, SDT-related variables and individual, interpersonal, community, and environment variables relevant to ACS will be based on SEM. The findings will provide a comprehensive understanding of the short-term effects of this school-based intervention on cycling to school behaviour, ACS and PA levels in Spanish adolescents.

Es fundamental elaborar un protocolo de evaluación para garantizar rigor y homogeneidad en cualquier estudio de investigación. Asimismo, se requieren consideraciones específicas si la investigación se desarrolla en contexto educativo y en diferentes centros educativos. Este trabajo tiene como objetivo describir el protocolo de evaluación del estudio de investigación titulado: Estudio PACO “Pedalea y Anda al Colegio”. Además, se aportan recomendaciones globales y aplicaciones prácticas en el contexto educativo. El principal objetivo del estudio PACO es fomentar el comportamiento de desplazamiento activo entre estudiantes de Educación Secundaria Obligatoria para mejorar los niveles de actividad física y otros indicadores de salud asociados. Por ello, el protocolo de evaluación incluye la metodología e instrumentos específicos para evaluar en los adolescentes variables como: 1) modo de desplazamiento al centro educativo y otros factores psicosociales asociados a dicho desplazamiento mediante el cuestionario PACO alumnos, 2) barreras familiares para el desplazamiento activo al centro educativo mediante el cuestionario PACO familias, 3) características antropométricas (peso, talla, perímetro de cintura y de cuello), 4) niveles de actividad física y gasto energético evaluados mediante acelererometría y 5) características de la ruta real casa-colegio registradas mediante Sistema de Posicionamiento Global. La transparencia en la metodología y logística necesaria para evaluar dichas variables en contexto educativo, es la clave para garantizar el rigor y la homogeneidad en futuras implementaciones, ya sean estas realizadas por investigadores o docentes. Finalmente, los datos obtenidos, serán fiables y relevantes para implementar estrategias educativas que fomenten la salud integral de los adolescentes. Abstract. It is essential to develop an evaluation protocol to develop rigor and homogeneity in any research study. Likewise, some considerations are specifically needed if the research is carried out in an educational context and in different schools. This work aims to describe y the evaluation protocol of the research study entitled: PACO Study “Cycle and Walk to School”. In addition, it provides global recommendations and practical applications in the educational context. The main objective of the PACO Study is to promote the behaviour of active commuting among students of Compulsory Secondary Education to improve their physical activity levels and other associated health indicators. For this reason, the evaluation protocol includes the specific methodology and instruments for evaluating variables such as: 1) mode of commuting to school and other psychosocial factors associated with active commuting through the PACO student questionnaire, 2) family barriers to active commuting to school through the PACO families questionnaire, 3) anthropometric characteristics (weight, height, waist and neck circumference), 4) levels of physical activity and energy expenditure evaluated by accelerometry and 5) characteristics of the real home-school route through a Global Positioning System. The transparency in the methodology and logistic necessary to evaluate the variables in the educational context is key to evaluate the rigor and homogeneity in future implementations, whether they are carried out by researchers or teachers. Finally, the obtained data will be reliable and relevant to implement educational strategies in order to promote an integral health of the adolescents.

Background Older adults present high risk of involvement in road crashes. Preventive interventions conducted by their primary healthcare physicians (PHPC) could reduce this public health issue. Objective The objective of this study was to design and validate a self-administered questionnaire that measures the knowledge, attitudes, and current practices (CP) of PHCP in Spain regarding the prevention of road injuries in older adults. Methods One thousand eight hundred and ninety-seven PHCP completed a questionnaire piloted previously in an expert panel and two convenience samples of physicians. It comprised 78 items grouped in five sections and was mainly focused on exploring three constructs: knowledge, attitudes, and CP. Exploratory factor analysis was used to obtain evidence of internal structure validity. Reliability was assessed through Cronbach’s α coefficient. Correlation coefficients for the scores constructed for each of the extracted factors were calculated to assess convergent and discriminant validity. Results Factor analysis extracted four factors each for the knowledge and attitudes constructs, and three factors for the CP construct, which explained more than 55% of the variance in each construct. Except for two factors of the knowledge construct regarding existing health problems associated to the risk of involvement in road crashes, the clustering pattern of all other items across the remaining nine factors was consistent and in agreement with previous knowledge. Cronbach’s α values were greater than 0.7 for all constructs. Conclusions Our questionnaire appears to be valid enough to assess the attitudes, CP, and medication-related knowledge of PHCP in Spain regarding the prevention of road injuries in older adults.