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IntroductionCar travel is associated with increased risk of morbidity and mortality, physical inactivity, traffic collisions and casualties, and air and noise pollution. Effective interventions are required to reduce car use and change travel behaviour to sustainable modes. We conducted an umbrella review: 1) determine effective interventions and intervention components to reduce car use and change travel behaviour; and 2) determine where effective components are situated by level of delivery (micro-, meso- or macro-level).MethodsFive databases were searched (2000–2022) for reviews implementing a systematic review process. Data synthesis involved the identification of effective intervention approaches and components and the structuring of components by delivery level. Reviews’ methodological quality was graded. Reviews were assessed for effectiveness (“negative”, “null”, “positive” or “inconclusive”) and consistency of results (“consistent” or “suggestive”).ResultsSearches identified 20,451 records, with 18 included. Eight reviews (moderate quality) were positive consistent (n = 6) or positive suggestive (n = 2) and focused on active school travel (n = 5), walking for transport (n = 1), organisational travel plans (n = 1) and teen mobility (n = 1). One active travel review (workplaces, low quality) was rated positive consistent, with the remaining positive consistent/suggestive reviews having critically low quality: car sharing (n = 1); passive to active travel (n = 1); soft interventions (n = 1); car use reduction (n = 2); and walking school buses (n = 1). Other moderate quality reviews were inconclusive (promotion of walking and cycling (n = 1) and bicycle active school travel (n = 1)) and null consistent (behavioural interventions, n = 1). The majority of effective components were micro-level, with no investigations into intervention cost-effectiveness or inequalities.ConclusionsThis review highlighted evidence to support active school travel, teen mobility, organisational travel plans and walking for transport as effective interventions. When combined, these interventions present a potentially healthy and sustainable life course approach. The majority of effective components were micro-level. More meso- and macro-level, cost-effectiveness and inequality investigations required.

Objective:The school food environment (SFE) is an ideal setting for encouraging healthy dietary behaviour. We aimed to develop an instrument to assess whole-SFE, test the instrument in the school setting and demonstrate its use to make food environment recommendations.Design:SFE literature and UK school food guidance were searched to inform instrument items. The instrument consisted of (i) an observation proforma capturing canteen areas systems, food presentation and monitoring of food intake and (ii) a questionnaire assessing food policies, provision and activities. The instrument was tested in schools and used to develop SFE recommendations. Descriptive analyses enabled narrative discussion.Setting:Primary schools.Participants:An observation was undertaken at schools in urban and rural geographical regions of Northern Ireland of varying socio-economic status (n 18). School senior management completed the questionnaire with input from school caterers (n 16).Results:The instrument captured desired detail and potential instrument modifications were identified. SFE varied. Differences existed between food policies and how policies were implemented and monitored. At many schools, there was scope to enhance physical eating environments (n 12, 67 %) and food presentation (n 15, 83 %); emphasise healthy eating through food activities (n 7, 78 %) and increase parental engagement in school food (n 9, 56 %).Conclusions:The developed instrument can measure whole-SFE in primary schools and also enabled identification of recommendations to enhance SFE. Further assessment and adaptation of the instrument are required to enable future use as a research tool or for self-assessment use by schools.

BackgroundEvidence regarding the effectiveness of 20 miles per hour (mph) speed limit interventions is limited, and rarely have long-term outcomes been assessed. We investigate the effect of a 20 mph speed limit intervention on road traffic collisions, casualties, speed and volume at 1 and 3 years post-implementation.MethodsAn observational, repeated cross-sectional design was implemented, using routinely collected data for road traffic collisions, casualties, speed and volume. We evaluated difference-in-differences in collisions and casualties (intervention vs control) across three different time series and traffic speed and volume pre-implementation, at 1 and 3 years post-implementation.ResultsSmall reductions in road traffic collisions were observed at year 1 (3%; p=0.82) and year 3 post-implementation (15%; p=0.31) at the intervention site. Difference-in-differences analyses showed no statistically significant differences between the intervention and control sites over time for road traffic collisions. There were 16% (p=0.18) and 22% (p=0.06) reductions in casualty rates at years 1 and 3 post-implementation, respectively, at the intervention site. Results showed little change in mean traffic speed at year 1 (0.2 mph, 95% CI −0.3 to 2.4, p=0.14) and year 3 post-implementation (0.8, 95% CI −1.5 to 2.5, p=0.17). For traffic volume, a decrease in 57 vehicles per week was observed at year 1 (95% CI –162 to −14, pConclusionA 20 mph speed limit intervention implemented at city centre scale had little impact on long-term outcomes including road traffic collisions, casualties and speed, except for a reduction in traffic volume. Policymakers considering implementing 20 mph speed limit interventions should consider the fidelity, context and scale of implementation.

Additional file 3. Intervention Components.

Additional file 2 : Appendix B. Household Survey.

Additional file 3 : Appendix C. Control Sample Characteristics (Control area sample (i.e. >1 mile radius from the greenway).

Additional file 1 : Appendix A. Description of the primary and secondary outcomes and measures.

Additional file 1.

Additional file 4 : Appendix D. Population trends in meeting physical activity recommendations in 2010 and 2016 by sex and age [Northern Ireland Health and Wellbeing Survey].

Additional file 6. Gender Analyses.

Additional file 1. CONSORT Checklist for Cluster Randomised Controlled Trial.

Additional file 1.