from building safer street crossings to establishing programs that encourage children and their parents to walk and bicycle safely to school (FHWA/ DOT, 2006). The Marin County, California, SRTS program, for example, is focused on reducing local automobile congestion around schools while promoting students’ healthy and sustainable habits. The program includes several components that have proven to be effective, including classroom education, special events, and incentives that encourage children and adolescents to choose alternative forms of transportation to schools, as well as technical assistance to identify and remove the barriers to walking, bicycling, carpooling, or taking transit to school. Evaluations of the SRTS program have demonstrated that making environmental changes can lead to increases in children’s physical activity patterns (Parisi Associates, 2002; Staunton et al., 2003) (Chapters 4 and 7). The California Department of Health Services has replicated the SRTS program in other cities, which has led to outcomes such as community audits of street, sidewalk, and bikeway conditions; the improved mobility of pedestrians and bicyclists; reduced speed and volume of motor vehicles; and improved motor vehicle compliance with traffic laws (Parisi Associates, 2002). Results linking the SRTS program to health outcomes for children and youth have not yet been reported.

Behavioral outcomes are the population and individual mediators of behavior (e.g., awareness, knowledge, attitudes, beliefs, values, preferences, and skills) and actual behavioral and social changes that affect dietary patterns and physical activity, and thus, energy balance. These outcomes not only are important at the individual level (such as outcomes desired by a pediatrician, nurse, or teacher when he or she is counseling a child or adolescent and his or her parents about healthy dietary practices and physical activity) but also apply on a population level to those implementing large-scale campaigns or programs targeting communities, states, or regions. An outcome of concern has been the potential for stigmatization of children and youth who are obese. Ongoing efforts are examining stigmatization as well as normalization of obesity (i.e., larger sizes and portions becoming the accepted norm).

Behavioral outcomes include changes in dietary patterns and physical activity for children and adolescents to achieve energy balance at a healthy weight. Planet Health is an example of an efficacious school-based intervention designed to reduce BMI levels and obesity prevalence in a multiethnic group of middle-school-aged children in an affluent setting. The program provided evidence that a well-planned and well-evaluated intervention aimed at reducing television viewing time, increasing physical activity, and improving nutrition behaviors can make a difference in reducing obesity prevalence in girls (Gortmaker et al., 1999). It is one of the few



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