Active transportation surveillance in children and adolescents: a global review using Active Healthy Kids Global Alliance Global Matrix 4.0 data

The current review aims to analyze and synthesize the current state of active transport (AT) surveillance and monitoring among children and adolescents globally, leveraging data from the Global Matrix 4.0 to identify gaps and opportunities for improving AT measurement. Two independent researchers systematically reviewed all evidence sources used by 57 countries/jurisdictions to assign AT grades. AT grades were predominantly in the mid-range, with most countries scoring between C- and B+. Over half (54%) of the countries used nationally representative data, although a substantial proportion relied on subnational or mixed sources. AT indicators were based on self-report questionnaires assessing the usual mode of transport (44%) or frequency of travel (34%), most often completed by children and adolescents. A few data sources included items on duration, trip diaries, and previous-day recall. AT assessment was largely restricted to school travel (66%), with minimal inclusion of other destinations. Less than 10% of sources reported any evidence of validity or reliability. The most frequently reported challenges in grade assignment were related to data limitations, methodological inconsistencies, and limited destination focus. Priorities for improvement of AT included infrastructure development, education and awareness initiatives, and urban and transport planning strategies, with consistent patterns observed across country income groups. This review highlights substantial heterogeneity in how countries monitor AT in children and adolescents. The inconsistent constructs, school-centric focus, and lack of reported reliability and validity of the items/tools hinder meaningful comparisons, long-term surveillance, and accurate assessment of children's and adolescents' actual AT behaviors. • Global analysis shows major inconsistencies in active transport assessment worldwide. • Active transport data mainly rely on single self-report items about school trips. • Non-school destinations and psychometric evidence rarely reported. • Methodological gaps hinder comparability and monitoring of active transport trends. • Call for Delphi consensus to harmonize active transport measures and reporting.