Is there a correlation between children’s outdoor active mobility behaviour and neighbourhood safety? A systematic review of the evidence

ObjectiveTo identify, summarise and evaluate evidence on the correlation between perceived and actual neighbourhood safety (personal and road danger) and diverse forms of outdoor active mobility behaviour (ie, active play, exercise, and travel) among primary-school-aged children.DesignA systematic review of evidence from observational studies exploring children’s active mobility behaviour and safety.Data sourcesSix electronic databases were searched: Google Scholar, PubMed, Scopus, Science Direct, ProQuest and Web of Science from study inception until July 2020.Data extraction and synthesisStudy selection and quality assessment were conducted independently by two reviewers. We expanded on a quality assessment tool and adopted a vote-counting technique to determine strength of evidence. The outcomes were categorised by individual, family and neighbourhood levels.ResultsA total of 29 studies were included, with a majority of cross-sectional design. Higher parental perceived personal safety correlated with increased children’s active mobility behaviour, but most commonly in active travel (eg, independent walking or cycling to a local destination). Increased concerns regarding road danger correlated with a decrease in each type of children’s active behaviour; active travel, play and exercise. However, these correlations were influenced by child’s sex/gender, age, car ownership, neighbourhood types, across time, and proximity to destination. Limited or inconclusive evidence was found on correlate of children’s outdoor active mobility behaviour to ‘stranger danger’, children’s perceived personal safety, race/ethnicity, socioeconomic status or measured safety.ConclusionChildren are restricted by perception of safety. Encouraging children’s active travel may require future strategies to address characteristics relevant to types of the neighbourhood that promote a high sense of personal safety. Children and parents may embrace other types of active mobility behaviour if road danger is mitigated. Sex/gender and age-specific interventions and redesign of public places could lead to child-friendly cities. Future studies may benefit from adopting validated measurement methods and fill existing research gaps.

A girl without stranger danger

Disinhibited social engagement disorder (DSED) is a rare disorder of childhood affecting a small number of children who experience extreme neglect or abuse in early childhood such as institutional rearing. The characteristic feature of DSED is disinhibited, socially indiscriminate social behavior that begins prior to the age of five years. Children with DSED exhibit reduced reticence in approaching unfamiliar adults, overly familiar behavior, lack of checking back with their caregiver after venturing away, and willingness to leave with an unfamiliar adult. The assessment includes a psychiatric evaluation and observation of how the child interacts with their caregiver and unfamiliar adults. There are no medication treatments for DSED; however, psychiatric comorbidities may benefit from psychopharmacology. The cornerstone of treatment for DSED is providing the child with an emotionally available attachment figure. It may be necessary to limit the child’s exposure to strangers for several months to reduce socially indiscriminate behaviors.