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Who owns the roads? How motorised traffic

discourages walking and bicycling
P L Jacobsen, F Racioppi and H Rutter
Inj Prev 2009 15: 369-373

doi: 10.1136/ip.2009.022566

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Original article

Who owns the roads? How motorised traffic

discourages walking and bicycling
P L Jacobsen,1 F Racioppi,2 H Rutter3
See Commentary, p 362
1

2771 14th Street, Sacramento,

California, USA; 2 Accidents,
Transport and Health, World
Health Organization Regional
Office for Europe, Rome, Italy;
3
National Obesity Observatory,
Oxford, UK
Correspondence to:
Mr P L Jacobsen, 2771 14th
Street, Sacramento, California
95818-2935, USA;
[email protected]
Accepted 18 June 2009

ABSTRACT
Objective: To examine the impact of traffic on levels of
walking and bicycling.
Method: Review of the literature of medical, public
health, city planning, public administration and traffic
engineering.
Results: The real and perceived danger and discomfort
imposed by traffic discourage walking and bicycling.
Accurately or not, pedestrians and bicyclists judge injury
risk and respond accordingly. Although it can be difficult
to measure these effects, observed behaviour provides
good evidence for these effects, with the strongest
association being an inverse correlation between volumes
and speeds of traffic and levels of walking and cycling.
Conclusion: Interventions to reduce traffic speed and
volume are likely to promote walking and bicycling and
thus result in public health gains.

Over the past two decades, the health consequences of physical inactivity have become increasingly apparent. Non-communicable diseases and
related conditions, such as overweight and obesity,
have increased steadily in Europe and the USA.
European health ministries have acknowledged
that physical inactivity, along with unhealthy
diets, plays a key role in the obesity epidemic,
and poses one of the most serious challenges to
public health in Europe. Many have endorsed the
promotion of physical activity, including stimulating cycling and walking, by better urban design
and transport policies.1
During the mid-1990s, an international scientific
consensus developed over the value of moderate
physical activityat least 30 min of physical
activity on most, preferably all, days of the week
for adultsin reducing risks of a number of noncommunicable diseases.2 Children and young people should participate in physical activity of at least
moderate intensity for 60 min per day. At a
frequency of at least twice a week, some of these
activities should help to enhance and maintain
muscular strength, flexibility and bone health.3 4
However, an analysis of a survey of European
Union countries showed that two-thirds of the
adult population did not reach recommended levels
of physical activity, and another survey showed
similar results among young people aged 11, 13 and
15 across Europe.5 6
Integrating physical activity into daily life is an
important factor in increasing population levels of
activity; bicycling and walking are major potential
contributors to this.7 8 Many journeys are short,
yet many of them are taken using cars. It has been
estimated that some 50% of these short trips could
Injury Prevention 2009;15:369373. doi:10.1136/ip.2009.022566

be walked or bicycled easily, thereby providing the

recommended amount of daily physical activity.79
In addition, switching from driving to walking
and cycling is important for reducing CO2 emissions.10 For example, it has been estimated that, if
the US population aged 1064 bicycled for 60 min
a day and therefore reduced their car use by that
distance bicycled, it could reduce US CO2 emissions by almost 11%.11
How people perceive traffic is an important but
poorly understood determinant of travel choices
and consequent levels of physical activity through
cycling and walking. In 2000, a report by the World
Health Organization (WHO) noted that the
impact of motorised traffic on people walking
and bicycling remained unquantified, but speculated that it might be the greatest health impact of
motorised traffic.12 This paper describes these links
and identifies possible entry points for corrective
interventions and areas for further study.
Five recent review articles examine some reasons
why people do not walk or bicycle. These articles
examine attitudes towards walking and bicycling,13
the relationship between the way neighbourhoods
are built and the amount of walking and bicycling,14 and what interventions encourage people to
walk and bicycle.1517 However, there is important
additional evidence that needs to be considered,
which is that people actually avoid walking and
bicycling near traffic.

METHOD
We searched for papers that reported observed
evidence that traffic discouraged walking and
cycling in medical, public health, city planning,
public administration and traffic engineering literature. This is an inchoate and poorly organised
area of research, with very few publications
identified through formal literature review, so the
majority of the papers were identified through our
professional networks. In these publications and
reports, specific evidence relating to the question
was often only presented incidentally.

RESULTS
Our literature search found that negative traffic
perceptions are associated with decreases in walking and bicycling. This finding was consistently
found across several types of studies.
A number of studies have observed people
avoiding dangerous and unpleasant traffic. Where
pedestrians and bicyclists are safer, levels of
walking and cycling tend to be higher, and vice
versa. Figure 1 shows the relationship between the
safety of cycling and the amount of cycling in 14
369

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Original article
European countries; this relationship is observed consistently
across a wide range of contexts.18
Traffic can delay, and hence deter, walking and bicycling.
Traffic also imposes injury risk on non-motorised travellers. In
Sweden and Denmark, roadway investment planning incorporate methods for quantifying this barrier effect.19
Fear of traffic can be seen in how and where pedestrians cross
streets. In the USA, 14% of the people on crosswalks ran rather
than walked across the road.20 Pedestrians are less likely to cross
streets if the crosswalk is unmarked. Where legs of an
intersection were otherwise matched and comparable, but only
one of the crosswalks was marked with paint, pedestrians
avoided the unmarked crosswalk in a 2/1 ratio. Young and older
pedestrians were even more likely to avoid the unmarked
crosswalk, more so as the number of traffic lanes increased.21
Even though motorists are legally obligated to yield at zebra
crossings, three out of four motorists use speed to intimidate
pedestrians into yielding. Only 5% of the motorists yield to
pedestrians.22
When roadways are equipped with sidewalks, nearly four
times as many people walk. More than six times as many people
walk along two-lane roads as four-lane roads.23
Men and women bicycle at different levels, possibly reflecting
different attitudes to risk. In communities with low levels of
cycling, more men than women bicycle, but, as the number of
bicyclists increases, the sex differences diminish.24
Neighbours are less likely to know and trust each other in
neighbourhoods with high traffic volume. Outdoor activities are
less common on high-traffic streets. Children are rarely found
playing except on the light-traffic streets. Residents felt their
delay in crossing streets increased as traffic volume increased.
The author of this study concluded that the impacts of traffic
on street life were extremely severe.25
The amount of walking and bicycling changes with both
long-term and short-term changes in traffic volume and speed.
Over two generations, the amount of walking and bicycling has
greatly decreased in many countries, with far fewer children
playing in the streets.26 Before automobiles dominated the
streets, children played in them.27 In the early 1900s, the advent
of motor vehicles was seen as gradually driving bicyclists from
the roads because of the dangerous and unpleasant nature of
motor vehicle use.28
In the long term, traffic volume and speed have increased. In
the USA, traffic volume increased 63% between 1980 and 1997,
almost three times faster than population growth.29 In Western
European countries, car use is now 2.5 times that of 1970.30

Eastern European traffic has grown tremendously, but it is

poorly documented.
In 1971 and again in 1990, children and parents from the
same five neighbourhoods in England were asked about their
freedom to travel. Despite essentially physically unchanged
neighbourhoods, the surveys show that whilst 80% of 7 and 8
year olds went to school on their own in the early 1970s, less
than 10% were doing so two decades later.26
This neighbourhood survey is matched by other, broader
surveys. In a recent 10-year period in the UK, childrens school
trips on-foot and on-bike have decreased by 10 percentage
points.31 In the USA, 48% of students walked or bicycled to
school in 1969. Today, fewer than 15% of children walk to
school and only 1% bicycle.32 In the USA, half of this change is
due to greater travel distances.33 However, for children who live
within a mile of school, the share of children walking or
bicycling to school also dropped precipitously, from close to
90% in 1969 to 31% 30 years later.32
The rapid motorisation in developing countries has been
accompanied by an even faster decline in bicycle riding. A
survey in China found that 43% of bicyclists have reduced
bicyclingand only 11% said it was because they had bought a
car. The main reason was the perceived increased danger in the
streets.34 In many African cities, bicycle use was common and
significant 20 or 30 years ago. For example, in Lusaka, Zambia,
the share of commute trips by bike was 55% in 1969. Now
bicycle use has become insignificant in the largest cities because
of the increasingly hostile and unsafe environment created by
motor vehicle traffic.35 In contrast, Bogota increased the use of
bicycles from less than 1% to 4% in 3 years by constructing
250 km of bicycle facilities and by promoting bicycle use,
including by closing many streets to motorised traffic on
Sundays.10
Interventions that reduce the danger of traffic to people
walking and bicycling, such as traffic calming, constructing
trails, closing or restricting use of roads, road user charging,
constructing bicycle infrastructure and implementing safe
routes to school programs, encourage walking and bicycling.1517

DISCUSSION
The real or perceived danger and unpleasantness of traffic
discourages walking and bicycling. There is both survey and
observational evidence for this and a strong association between
increasing speeds and volumes of traffic and decreasing levels of
walking and cycling.

Methodological strengths and weaknesses of the study

Figure 1 Fatalities/100 million km cycled as a function of distances

travelled/day/capita in 14 European countries.17
370

In most urban areas around the world it is difficult to find

locales where traffic danger is not a continuing reality of
everyday lifetraffic and traffic danger are almost ubiquitous
yet have rarely been studied as a causal component of peoples
physical inactivity.
Given its ubiquity, it is hard to isolate the role of traffic from
other factors influencing active travel behaviour. Indeed, many
people, including researchers, are so accustomed to exposure to
traffic that they may find it hard to conceive of a world without
it; the influence of traffic on walking and cycling remains
largely unresearched.
This omission also extends to interpreting injury statistics. In
1999, the US Centers for Disease Control and Prevention
celebrated the 41% decrease in number of pedestrians killed over
a 22-year period,36 but they apparently did not consider the
importance of the amount of walking. For young children, their
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Original article
Figure 2 School age children in USA:
safer streets or less walking and
bicycling?

70% decrease in fatalities matches their 67% decrease in walking

to school (fig 2),32 37 while among middle-aged pedestrians, the
decrease in their fatality rate (10%) was less than their decrease
in walking (30% decrease in walk-to-work rate).37 38 So the
decline in injuries may reflect to a significant extent lower levels
of exposure to danger among the population, rather than any
true reduction in road danger. This has also been observed in the
UK.39
It is also important to note that improved medical care has
increased the likelihood of survival in the event of a motor
vehicle crash.40 For these two reasons, fatality statistics, in
isolation from other information, are an inadequate measure of
the traffic danger faced by people walking and bicycling.
Traffic can also discourage physical activity by making
walking and bicycling unpleasant. Streets in new neighbourhoods are often designed primarily around the needs of
motorists and are thus unattractive for pedestrians. Many
newer neighbourhoods separate land uses and devote more

Figure 3

British injury prevention campaign.

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Figure 4

US injury prevention campaign.

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Original article
What is already known on the subject
c
c

People do not walk and bicycle for a variety of reasons.

Most of the research on barriers to cycling and walking to date
focuses on attitudes and the built environment.

What this study adds

c

Traffic, because it is dangerous and unpleasant, discourages

walking and bicycling.
Increasing traffic volume or speed discourages walking and
bicycling and therefore harms health.

space to parking and roads than to the needs of pedestrians and

cyclists. They thus have greater distances between destinations,
which discourages walking and bicycling.41 Many communities
built before motor vehicles have yielded public spaces to
parking, and their roads have filled with traffic.
The evidence on the relationship between perceptions of the
traffic environment and walking and cycling is consistent in
showing an inverse association between traffic danger (or
perceived danger) and levels of walking and cycling. However,
the majority of the evidence is observational, and is confounded
by hard-to-isolate issues such as cultural attitudes to driving and
perceptions of convenience.13 This review is not systematic, and
thus may suffer from biases and oversights. Although this does
not diminish the significance of the identified effects, it
highlights the need for well-structured research to address these
important public health issues.

Results in relation to other studies

The evidence on determinants of walking and cycling describes
a wide range of factors, from environmental to personal.13 14 4143
Much of this research has focused on the built environment,
which is relatively easy to measure. Some neighbourhoods deter
walking and bicycling by segregating land use, low residential
density and infrequent street intersections.14 41 42
Perceptions of risk of being injured by motorised traffic affect
decisions to drive, walk, bicycle or use public transport.44
Perceptions differ from true risk because of cultural influences
and the individual characteristics of the people experiencing the
fear.44 Fear may suppress walking and bicycling in several ways.
Fear of crime is known to discourage physical activity.38 Air
pollution and vehicular exhaust and noise probably discourage
walking and bicycling. In addition, neighbourhood conditions
such as poor walking surfaces and loose dogs reduce walking
and bicycling.38

Meaning of the results for policy

Changing land use and reshaping population density take a long
time and have high costs. On the other hand, traffic can be
made less dangerous and more pleasant relatively quickly and
inexpensivelyfor example, through traffic calming, 30 km/h
zones, congestion charging, providing cycle tracks on major
streets, and giving priority to the rights and safety of vulnerable
road users as opposed to motorised transport. This provides an
important opportunity to develop a health-improving environment that supports physical activity and contributes to
372

Policy implications
c

Compared with rebuilding streets and neighbourhoods, traffic

can be made less dangerous and more pleasant quickly and
relatively inexpensivelyfor example, through traffic calming
interventions, congestion charging, enforcement of speed
limits and prioritisation of the rights of pedestrians and cyclists
over motorised traffic.
Society can encourage physical activity and counteract noncommunicable diseases and obesity by making traffic less
dangerous and more pleasant.

reductions in risks for non-communicable diseases, obesity and

related health problems.
Cooperation and coordination is needed between health
promotion efforts to reduce injuries and increase walking and
bicycling.
The British injury prevention campaign of the early 1990s,
One False Move and Youre Dead (fig 3) was criticised for
using fear,26 which, as shown, discourages walking and
bicycling. Nonetheless, many injury prevention efforts continue
to use fear. Figure 4 shows an injury prevention campaign
poster produced by the US Government in 2007, which uses the
outline of a corpse to remind people that motorists can kill them
while they walk in their own neighbourhoods.45
Society has often placed the responsibility for preventing
injuries on the person walking or bicycling. Soon after the
automobiles creation, its proponents worked to reconstruct the
meaning of safety, removing the connection between speed and
danger. Car proponents crafted safety campaigns that placed
the burden for preventing injury on the person walking,
generating the term jaywalker for the person who failed to
show deference to the motorist by walking where and how they
always had. Car proponents had the major control in writing
traffic laws and developing traffic engineering policies, and these
favour the motorist over other road users.27 Pedestrianseven
childrenare often blamed for their injuries.46 Injury prevention
research often reflects this perspective. For example, a study of
seriously injured bicyclists found that motor vehicle involvement was overwhelmingly the greatest risk factor.47 However,
the authors considered helmets, separation of cyclists from
motor vehicles and delaying cycling until children are developmentally ready as part of the recommendations to prevent
injuries, which contribute to reinforcing the fear of cycling, and
did not consider effective measures such as lowering traffic
speeds to make roads safer for bicyclists. Society often still
terms traffic crashes accidents, a term that excuses the
perpetrator, diminishes the concerns of the victim, and
perpetuates the myth of inevitability.48 Although motorists
with a history of traffic citations are known to be at increased
risk of colliding with child pedestrians, society allows them to
continue to drive, implicitly valuing their mobility above the
safety of others.49

Unanswered questions and future research

The role of fear-based road safety efforts in reducing physical
activity, and hence health, deserves further investigation. It
seems likely that traffic safety efforts that evoke fear in the
potential victims discourage walking and cycling. If fewer
people walk or bicycle, then each remaining walker or bicyclist
is in greater danger.18
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Original article
Given that many roadway projects make traffic more
dangerous and less pleasant, the effects on people walking and
bicycling should be routinely measured. Routine monitoring of
walking and bicycling would address this, and allow identification of positive as well as negative effects of transport
interventions.
The health benefits of increased physical activity resulting
from changes in walking and cycling should be quantified and
included in appraisals of transport projects. This approach can
be used for schemes such as the London congestion charge as
well as engineering and infrastructure projects.50 Tools such as
the WHO health economic assessment tool for cycling51 provide
a powerful mechanism for doing this.
The evidence presented here shows that reducing traffic speed
and volume encourages walking and bicycling. A shift in focus
away from prioritisation of motorised mobility to a wider
consideration of transport impacts, including the indirect
impacts of traffic danger on physical activity, is an important
step in moving towards a healthier, more active, and less obese
society.
Competing interests: None.

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29.

We presented this paper, in an earlier form, at the 15 May 2006 WHO European
Environment and Health Committee, Oslo.
Provenance and peer review: Not commissioned; externally peer reviewed.

REFERENCES
1.
2.
3.
4.
5.
6.

7.
8.
9.
10.

11.
12.
13.
14.
15.
16.

WHO Regional Office for Europe. European charter on counteracting obesity.

Copenhagen, 2006. http://www.euro.who.int/Document/E89567.pdf (accessed 15
Jul 2009).
Pate R, Pratt M, Blair S, et al. Physical activity and public health: a recommendation
from the Centers for Disease Control and Prevention and the American College of
Sports Medicine. JAMA 1995;273:4027.
Biddle S, Sallis JF, Cavill N, eds. Young and active? Young people and healthenhancing physical activity: evidence and implications. London: Department of Health,
2004.
Strong WB, et al. Evidence-based physical activity for school-age youth. J Pediatr
2005;146:7327.
Sjostro
m M, et al. Health-enhancing physical activity across European Union
countries: the Eurobarometer study. J Public Health 2006;14:110.
WHO Regional Ofiice for Europe. Young peoples health and health-related
behaviour. In: Currie C, Roberts C, Morgan A, et al, ed. Young peoples health in
context. Health Behaviour in School-aged Children (HBSC) study: international report
from the 2001/2002 survey. Copenhagen: WHO Regional Office for Europe, 2004:53
161 (Health Policy for Children and Adolescents, No. 4). http://www.euro.who.int/
InformationSources/Publications/Catalogue/20040601_1 (accessed 28 Jul 2006).
WHO Regional Office for Europe. Steps to health: a European Framework to
promote physical activity for health. Copenhagen, 2007. http://www.euro.who.int/
Document/E90191.pdf (accessed 15 Jul 2009).
WHO Regional Office for Europe. Physical activity and health in Europe: evidence
for Action. Copenhagen, 2006. http://www.euro.who.int/Document/e89490.pdf
(accessed 15 Jul 2009).
European Commission. WALCYING: how to enhance WALking and CYcliNG instead
of shorter car trips and to make these modes safer: final project report, 1997. http://
cordis.europa.eu/transport/src/walcyngrep.htm (accessed 15 Jul 2009).
Ribeiro K, Kobayahshi S, Beuthe M, et al. Transport and its infrastructure. In: Metz
B, Davidson OR, Bosch PR, et al, eds. Climate change 2007: mitigation. Contribution of
Working Group III to the Fourth Assessment Report of the Intergovernmental Panel on
Climate Change. Cambridge, UK and New York, USA: Cambridge University Press,
2007.
Higgins PAT, Higgins M. A healthy reduction in oil consumption and carbon
emissions. Energy Policy 2005;33:14.
WHO Regional Office for Europe. Transport, environment and health (Dora C,
Phillips M, eds). Copenhagen, 2000. http://www.euro.who.int/document/e72015.pdf
(accessed 15 Jul 2009).
Lorenc T, Brunton G, Oliver S, et al. Attitudes to walking and cycling among children,
young people and parents: a systematic review. J Epidemiol Community Health
2008;62:8527.
Saelens BE, Handy SL. Built environment correlates of walking: a review. Med Sci
Sports Exerc 2008;40(7 Suppl):S55066.
Ogilvie D, Egan M, Hamilton V, et al. Promoting walking and cycling as an alternative
to using cars: systematic review. BMJ 2004;329:7636.
Ogilvie D, Foster CE, Rothnie H, et al. Interventions to promote walking: systematic
review. BMJ 2007;334:1204.

Injury Prevention 2009;15:369373. doi:10.1136/ip.2009.022566

30.

31.
32.

33.
34.
35.
36.

37.

38.

39.
40.
41.
42.
43.

44.
45.
46.
47.
48.
49.
50.
51.

NICE. Physical activity and the environment. Review one: transport. London: National
Institute for Health and Clinical Excellence, 2006.
Jacobsen PL. Safety in numbers: more walkers and bicyclists, safer walking and
bicycling. Inj Prev 2003;9:2059.
Victoria Transportation Policy Institute. Transportation cost and benefit analysis:
techniques, estimates and implications. 2nd edn. Victoria, BC: Victoria Transportation
Policy Institute, 2009. http://www.vtpi.org/tca/ (accessed 31 Jul 2009).
Transportation Research Board. Transit Cooperative Research Program and
Cooperative Highway Research Program. Improving pedestrian safety at unsignalized
crossings. Washington, DC: Transportation Research Board, 2006.
Zegeer CV, Stewart JR, Huang H, et al. Safety effects of marked versus unmarked
crosswalks at uncontrolled locations: executive summary and recommended
guidelines. McLean, VA: Federal Highway Administration. FHWA-RD-01-075. Feb
2002.
Varhelyi A. Drivers speed behaviour at a zebra crossing: a case study. Accid Anal
Prev 1998;30:73143.
Qin X, Ivan JN. Estimating pedestrian exposure prediction model in rural areas.
Transp Res Rec 2001;1773:8996.
Anonymous. Gender and critical mass: do high cycle flows correlate with a high
proportion of female cyclists? London Analytics Research Journal 2005. http://www.
londonanalytics.info/research-journal/issue1 (accessed 29 Nov 2005).
Appleyard D. Livable streets. Berkeley: University of California Press, 1981.
Hillman M, Adams J, Whitelegg J. One false move: a study of childrens independent
mobility. London: Policy Studies Institute, 1990.
Norton PD. Fighting traffic: the dawn of the motor age in the American city.
Cambridge, MA: MIT Press, 2008.
Anonymous. Cycling and motor-cars. Lancet 1903;161:1460.
US Environmental Protection Agency. Our built and natural environments: a
technical review of the interactions between land use, transportation, and
environmental quality. Washington, DC: US Environmental Protection Agency, EPA
231-R-01-002, January 2001.
European Commission Directorate-General for Energy and Transport in
cooperation with Eurostat. Energy & transport in figures 2004. Brussels: European
Commission, 2004.
UK Department for Transport. National travel survey; 2002 update, revised 2004.
London: UK Department for Transport.
US Environmental Protection Agency. Travel and environmental implications of
school siting. Washington, DC: US Environmental Protection Agency, EPA 231-R-03004, October 2003.
McDonald NC. Active transportation to school: trends among U.S. schoolchildren,
19692001. Am J Prev Med 2007;32:50916.
York G. Cars conquering the bicycle kingdom. Globe and Mail 2007 Jan 20.
Howe J. The headloading and footpath economy: walking in Sub-Saharan Africa.
World Transport Policy and Practice 2001;7:812.
US Centers for Disease Control and Prevention. Achievements in public health,
19901999. Motor vehicle safety: a 20th century public health achievement. MMWR
Morb Mortal Wkly Rep 1999;48:36974.
National Highway Traffic Safety Administration. Traffic safety facts, 2001.
Washington, DC: Department of Transportation, National Highway Traffic Safety
Administration, 2002.
Loukaitou-Sideris A. Is it safe to walk? Neighborhood safety and security
considerations and their effects on walking. Journal of Planning Literature
2006;20:21932.
DiGuiseppi C, Roberts I, Li L. Influence of changing travel patterns on child death
rates from injury: trend analysis. BMJ 1997;314:71013.
Nathens AB, Jurkovich GJ, Cummings P, et al. The effect of organized systems of
trauma care on motor vehicle crash mortality. JAMA 2000;283:19904.
Saelens BE, Sallis JF, Black JB, et al. Neighborhood-based differences in physical
activity: an environment scale evaluation. Am J Public Health 2003;93:15528.
Owen N, Humpel N, Leslie E, et al. Understanding environmental influences on
walking: review and research agenda. Am J Prev Med 2004;27:6776.
Saelens BE, Sallis JF, Frank LD. Environmental correlates of walking and cycling:
findings from the transportation, urban design, and planning literatures. Ann Behav
Med 2003;25:8091.
Noland RB. Perceived risk and modal choice: risk compensation in transportation
systems. Accid Anal Prev 1995;27:50321.
US Department of Transportation. Reducing highway fatalities. http://safety.fhwa.
dot.gov/ped_bike/materials/pdf/fhwa-sa-06-07.pdf (accessed 11 Dec 2007).
Roberts I, Coggan C. Blaming children for child pedestrian injuries. Soc Sci Med
1994;38:74953.
Rivara FP, Thompson DC, Thompson RS. Epidemiology of bicycle injuries and risk
factors for serious injury. Inj Prev 1997;3:11014.
Stewart AE, Lord JH. Motor vehicle crash versus accident: a change in terminology
is necessary. J Trauma Stress 2002;15:3335.
Lightstone AS, Peek-Asa C, Kraus JF. Relationship between drivers record and
automobile versus child pedestrian collisions. Inj Prev 1997;3:2626.
Transport for London. Congestion charging: Fifth Annual Monitoring Report. London;
Mayor of London, July 2007.
WHO Regional Office for Europe. Health economic assessment tool for cycling
(HEAT for cycling). 2007. http://www.euro.who.int/eprise/main/WHO/Progs/TRT/
policy/20070503_1?language= (accessed 9 Jun 2008).

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