Interventions to improve pedestrian and cyclist safety in Latin America: a systematic review and metasummary


Pedestrian, Cyclists, Vulnerable Road Users, Safety, Interventions, Latin America, Active Transportation

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Trejo Tello, K., Hughey, S. M., Porto, S., Hart, M., & Benson, A. (2022). Interventions to improve pedestrian and cyclist safety in Latin America: a systematic review and metasummary. Journal of Healthy Eating and Active Living, 2(2), 45–59.


Road user fatalities account for one of the leading causes of preventable death in Latin America with pedestrians and bicyclists at higher risk for more extensive injuries as compared to other road users. Despite these vulnerable road user (VRU) risks, encouraging individuals to walk and cycle is an important public health strategy for addressing the region's obesity epidemic through promoting regular physical activity via active transportation (AT). However, in order to promote AT as a viable source of physical activity, safety of the VRU must be considered. Interventions to improve VRU safety are critical but a current understanding of the impact of these interventions in the region is lacking. The purpose of this systematic review and metasummary is to describe the effectiveness of interventions that have been implemented in Latin America to improve pedestrian and bicyclist safety. A systematic literature search of public health, policy and engineering databases was completed using search terms generated through the PICO method. The PRISMA framework was used to screen articles for inclusion and analysis. Eight articles detailing nine interventions across four countries were included for final synthesis and organized according to the Three E’s Model of Injury Prevention (Education, Engineering and Enforcement). Interventions assessed outcomes related to VRU safety ranging from attitudes and behaviors to fatal injuries, with only enforcement-based interventions reporting on the latter. Evidence-based interventions to inform the design of programs to promote AT and VRU safety in the region are lacking and should be of urgent public health priority.


Abreu, D. R. de O. M., Souza, E. M. de, & Mathias, T. A. de F. (2018). Impact of the Brazilian Traffic Code and the Law Against Drinking and Driving on mortality from motor vehicle accidents. Cadernos De Saude Publica, 34(8), e00122117.

Allerton, H. (2001). Mime Patrol. Training & Development, 55(4), 88.

Andrade, L. O. M., Bareta, I. C. de H. C., Gomes, C. F., & Canuto, O. M. C. (2005). Public health policies as guides for local public policies: The experience of Sobral-Ceará, Brazil. Promotion & Education, Suppl 3, 28–31.

Bacchieri, G., Barros, A. J. D., Santos, J. V. dos, Gonçalves, H., & Gigante, D. P. (2010). A community intervention to prevent traffic accidents among bicycle commuters. Revista De Saude Publica, 44(5), 867–875.

Baker, S. P. (1975). The man in the street: A tale of two cities. American Journal of Public Health, 65(5), 524–525.

Casey, N. (2013, May 29). A Very Pedestrian Superhero Grapples With Mexico City Traffic—WSJ. Wall Street Journal.

Centers for Disease Control and Prevention. (2021, June 7). Defining Adult Overweight and Obesity. Centers for Disease Control and Prevention.

Community Preventive Services Task Force. (2016). Physical Activity: Built Environment Approaches Combining Transportation System Interventions with Land Use and Environmental Design.

Community Preventive Services Task Force. (2018). Physical Activity: Interventions to Increase Active Travel to School.

de Sá, T. H., de Rezende, L. F. M., Borges, M. C., Nakamura, P. M., Anapolsky, S., Parra, D., Adami, F., & Monteiro, C. A. (2017). Prevalence of active transportation among adults in Latin America and the Caribbean: A systematic review of population-based studies. Revista Panamericana de Salud Pública, 41.

Duperrex, O., Roberts, I., & Bunn, F. (2002). Safety education of pedestrians for injury prevention. The Cochrane Database of Systematic Reviews, 2002(2).

Falavigna, A., Teles, A. R., Velho, M. C., Medeiros, G. S., Canabarro, C. T., de Braga, G. L., Barazzetti, D. O., Vedana, V. M., & Kleber, F. D. (2012). Impact of an injury prevention program on teenagers’ knowledge and attitudes: Results of the Pense Bem-Caxias do Sul Project. Journal of Neurosurgery. Pediatrics, 9(5), 562–568.

Food and Agriculture Organization of the United Nations. (2021). Regional Overview of Food Security and Nutrition in Latin America and the Caribbean 2020 – Food security and nutrition for lagged territories – In brief.

Giles, A., Bauer, M. E. E., & Jull, J. (2020). Equity as the fourth ‘E’ in the ‘3 E’s’ approach to injury prevention. Injury Prevention, 26(1), 82–84.

Groeger, J. A. (2011). How Many E’s in Road Safety? In B. E. Porter (Ed.), Handbook of Traffic Psychology (pp. 3–12). Academic Press.

Henderson, I. (2017, February 7). Big in Bolivia: Zebras in the Streets. The Atlantic.

Huicho, L., Adam, T., Rosales, E., Paca-Palao, A., López, L., Luna, D., Miranda, J. J., & PIAT Working Group. (2012). Evaluation of interventions on road traffic injuries in Peru: A qualitative approach. BMC Public Health, 12(1), 71.

Hyder, A. A., Norton, R., Pérez-Núñez, R., Mojarro-Iñiguez, F. R., Peden, M., & Kobusingye, O. (2016). The Road Traffic Injuries Research Network: A decade of research capacity strengthening in low- and middle-income countries. Health Research Policy and Systems, 14.

Martínez, P., & Contreras, D. (2020). The effects of Chile’s 2005 traffic law reform and in-country socioeconomic differences on road traffic deaths among children aged 0-14 years: A 12-year interrupted time series analysis. Accident; Analysis and Prevention, 136, 105335.

Martinez, S., Sanchez, R., & Yañez-Pagans, P. (2019). Road safety: Challenges and opportunities in Latin America and the Caribbean. Latin American Economic Review, 28(1), 17.

Mohan, D., Jha, A., & Chauhan, S. S. (2021). Future of road safety and SDG 3.6 goals in six Indian cities. IATSS Research, 45(1), 12–18.

Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & Group, T. P. (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLOS Medicine, 6(7), e1000097.

Otero, S., & Rau, T. (2017). The effects of drinking and driving laws on car crashes, injuries, and deaths: Evidence from Chile. Accident Analysis & Prevention, 106, 262–274.

Pan American Health Organization. (2019). Status of Road Safety in the Region of the Americas. Pan American Health Organization.

Poggio, R., Serón, P., Calandrelli, M., Ponzo, J., Mores, N., Matta, M. G., Gutierrez, L., Chung-Shiuan, C., Lanas, F., He, J., Irazola, V., Rubinstein, A., & Bazzano, L. (2016). Prevalence, Patterns, and Correlates of Physical Activity Among the Adult Population in Latin America: Cross-Sectional Results from the CESCAS I Study. Global Heart, 11(1), 81-88.e1.

Pollack, K. M., Bailey, M. M., Gielen, A. C., Wolf, S., Auld, M. E., Sleet, D. A., & Lee, K. K. (2014). Building safety into active living initiatives. Preventive Medicine, 69 Suppl 1, S102-105.

Radjou, A. N., & Kumar, S. M. (2018). Epidemiological and Clinical Profile of Fatality in Vulnerable Road Users at a High Volume Trauma Center. Journal of Emergencies, Trauma, and Shock, 11(4), 282–287.

Raffo, V., Bliss, T., Shotten, M., Sleet, D., & Blanchard, C. (2013). Case study: The Argentina Road Safety Project: lessons learned for the Decade of Action for Road Safety, 2011–2020. Global Health Promotion, 20(4 Suppl), 20–36.

Ramos-Castañeda, J., Barreto dos Santos, F., Martínez-Vega, R., Galvão de Araujo, J. M., Joint, G., & Sarti, E. (2017). Dengue in Latin America: Systematic Review of Molecular Epidemiological Trends. PLoS Neglected Tropical Diseases, 11(1), e0005224.

Rivara, F. P. (2001). Booster seats for child passengers: Lessons for increasing their use. Injury Prevention, 7(3), 210–213.

Rivera, J. Á., de Cossío, T. G., Pedraza, L. S., Aburto, T. C., Sánchez, T. G., & Martorell, R. (2014). Childhood and adolescent overweight and obesity in Latin America: A systematic review. The Lancet. Diabetes & Endocrinology, 2(4), 321–332.

Sallis, J. F., Frank, L. D., Saelens, B. E., & Kraft, M. K. (2004). Active transportation and physical activity: Opportunities for collaboration on transportation and public health research. Transportation Research Part A: Policy and Practice, 38(4), 249–268.

Staton, C., Vissoci, J., Gong, E., Toomey, N., Wafula, R., Abdelgadir, J., Zhou, Y., Liu, C., Pei, F., Zick, B., Ratliff, C. D., Rotich, C., Jadue, N., de Andrade, L., von Isenburg, M., & Hocker, M. (2016). Road Traffic Injury Prevention Initiatives: A Systematic Review and Metasummary of Effectiveness in Low and Middle Income Countries. PLoS ONE, 11(1).

Torres, A., Sarmiento, O. L., Stauber, C., & Zarama, R. (2013). The Ciclovia and Cicloruta Programs: Promising Interventions to Promote Physical Activity and Social Capital in Bogotá, Colombia. American Journal of Public Health, 103(2), e23–e30.

Treviño-Siller, S., Pacheco-Magaña, L. E., Bonilla-Fernández, P., Rueda-Neria, C., & Arenas-Monreal, L. (2017). An educational intervention in road safety among children and teenagers in Mexico. Traffic Injury Prevention, 18(2), 164–170.

United Nationals Statistics Division. (n.d.). Sustainable Development Goals (SDG) Indicators—Metadata repository. Retrieved February 21, 2022, from

World Health Organization. (2010). Global recommendations on physical activity for health.

World Health Organization. (2018). Global Status Report on Road Safety 2018. World Health Organization.

World Health Organization. (2020a). Physical activity.

World Health Organization. (2020b, October 23). Lima responds to the COVID-19 pandemic on wheels.

World Health Organization. (2021). Decade of Action for Road Safety, 2021-2030. World Health Organization.,deaths%20and%20injuries%20by%202030.

Young, D. R., Cradock, A. L., Eyler, A. A., Fenton, M., Pedroso, M., Sallis, J. F., Whitsel, L. P., & American Heart Association Advocacy Coordinating Committee. (2020). Creating Built Environments That Expand Active Transportation and Active Living Across the United States: A Policy Statement From the American Heart Association. Circulation, 142(11), e167–e183.

Zieff, S. G., Musselman, E. A., Sarmiento, O. L., Gonzalez, S. A., Aguilar-Farias, N., Winter, S. J., Hipp, J. A., Quijano, K., & King, A. C. (2018). Talking the Walk: Perceptions of Neighborhood Characteristics from Users of Open Streets Programs in Latin America and the USA. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 95(6), 899–912.

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Copyright (c) 2022 Kathleen Trejo Tello, Morgan Hughey, Sarah Porto, Molly Hart, Anna Benson