Systematic review of how Play Streets impact opportunities for active play, physical activity, neighborhoods, and communities

Physical activity is an important determinant of obesity risk, which is a major public health problem in school-aged children in the United States (U.S.) and globally [1, 2]. In fact, physical inactivity is the fourth leading risk factor for mortality globally [3]. Regular physical activity in childhood and adolescence also helps build healthy bones and muscles, reduces anxiety and stress, increases self-esteem, and may improve blood pressure and cholesterol levels [4]. Yet, nearly 4 out of 5 U.S. children and adolescents do not meet national physical activity guidelines, with the majority of children and adolescents residing in other countries not meeting World Health Organization (WHO) physical activity guidelines (England: 22% of children (5–15 years of age), Australia: 19% of children (5–17 years of age), Belgium: 7% of children (6–9 years of age) and 2% of adolescents (10–17 years of age), Chile: 25% of children (6–9 years of age) on weekdays and 14% on weekend days) [5‐10]. Guidelines for physical activity from both the U.S. and WHO, state that children and adolescents should participate in 60 min or more of physical activity per day. Most of the 60 min should be moderate to vigorous aerobic activity. In addition, vigorous aerobic, muscle-strengthening, and bone-strengthening physical activity should be incorporated as part of the required 60 min or more at least 3 days a week [3, 4].

Disparities in physical activity levels and access to opportunities for activity exist [4], making it challenging for some children to meet recommended physical activity levels. Features of the built environment, including sidewalks, parks, connectivity, and traffic patterns have been associated with physical activity among children [11]. In many underserved and under-resourced communities, built environment characteristics positively associated with physical activity (e.g., sidewalks, parks, connectivity, traffic patterns) are often lacking, and spaces for physical activity are more frequently perceived by parents as unsafe for children due to crime and violence [12].

Play Streets is an intervention that can address these inequities and increase access to safe places for physical activity and active play globally. Play Streets are the temporary closure of streets, that for a specified time period (around 3–5 h) create a safe, publicly accessible space for children, adolescents, and/or their families to engage in active play (closures can be recurring or episodic) [13‐17]. Most Play Streets are supervised in some capacity, include multiple activity areas using loose or temporary equipment (e.g., hula hoops, inflatable/bounce house, balls/sports, etc.…), and usually occur during summer months. Although Play Streets have gained in popularity in recent years [18], use of these approaches date back to as early as the 1920s in the U.S. and 1930s in the United Kingdom (U.K.) [19‐21]. The idea of creating temporary play space in streets or other publicly available spaces (e.g., parking lots) is similar to “pop-up” parks/play areas, and also could be seen as part of larger community events, such as in the Open Streets and Ciclovías. Pop-up parks occur when a segment of a street or a parking lot is closed off and used to create a temporary public space [22]. Unlike most Play Streets, pop-up parks typically include temporary play structures and resemble a park, rather than an open play space with some activities [22]. Ciclovías and Open Streets initiatives are broad all-community events lasting a few hours to a full day, that similar to Play Streets, close a section of, or entire, street(s) to vehicular/motorized traffic. Open Streets and Ciclovía initiatives usually promote community connectivity, walking, jogging, and cycling, while also providing opportunities for residents to engage in and be exposed to other less common physical activity opportunities through “activity hubs” with organized activities (e.g., yoga, dance classes, sports demonstrations, etc.…) [23, 24]. Since little detail is usually reported describing activity hubs, it is possible that some Ciclovía and Open Streets initiatives incorporate a Play Streets “style” component as part of an activity hub to allow for general active play for children, adolescents, and/or their families [23, 24]. In the U.S. and U.K., Play Streets are the most common of these initiatives focused on increasing opportunities for children’s active play, with 660 streets in the U.K. hosting regular Play Streets as of June 2018 and cities in the U.S. such as Chicago hosting over 650 summer Play Streets since 2012, Seattle hosting over 350 since 2013, and San Francisco hosting Play Streets in 2013, 2017, and 2018 [13, 14, 25‐27]. In other countries Ciclovía and Open Streets events are more common, with the potential of incorporating Play Streets “style” components as part of activity hubs, such as in Bogotá, Colombia where Ciclovías have been a weekly occurrence since 1974 [28].

Play Streets address health inequities by providing places for safe active play for children and adolescents in neighborhoods without access to safe and/or well-maintained parks and playgrounds [13, 14]. Play Streets also have the potential to help raise awareness and build a culture around the need for safe built environments and traffic safety interventions in communities [13‐16]. In addition, Play Streets initiatives have enhanced neighborhoods through partnership building and increasing social cohesion of residents within the community [13‐16].

While the present need for Play Streets is apparent in many communities either lacking parks or other built/natural physical activity spaces or facing safety concerns, Play Streets have been implemented in communities for roughly a century. Some of the earliest Play Streets resulted from a focus on reducing pedestrian-motor vehicle crashes, while also providing a play space for people in crowded urban areas [21, 29]. Most of the Play Streets during this time were coordinated by city agencies [19‐21, 29], and were highly structured, with specific instructions for set-up [29] and games offered (e.g., group sports, individual sidewalk activities) [21]. Success of these Play Streets was measured by counting the number of children who registered for Play Streets and the number who attended [21]. Parents were not usually present since activities catered to children and staff were on hand to supervise [21, 29].

The focus of Play Streets began to shift in the 1970s to creating a social neighborhood environment for children and adolescents, and coordination was assumed by block and/or neighborhood associations [30, 31]. Surveys of Play Streets participants were the main way they were evaluated [19, 20], and results indicated that Play Streets increased social engagement and reduced the immediate need for a permanent playground in the community [31]. After these efforts, Play Streets began to spread to large, densely populated cities, with local organizations and government agencies often leading implementation [31].

Although Play Streets have been implemented across multiple decades, their recent resurgence highlights a need to better understand their impacts and the evidence base for their implementation. To address this gap, the primary aim of this study was to document how Play Streets impact opportunities for safe active play and physical activity for children and adolescents. Secondary aims were to describe neighborhood and community impacts and examine evaluation methods used in each study in order to inform future evaluation research as Play Streets continue to grow in popularity.

The initial literature search identified 15,122 articles, with three additional articles identified through researcher recommendation or in review of article reference lists. Of these 15,125 initial articles, 275 were identified as relevant through reviewing article titles. Duplicates were removed (n = 95), leaving 180 articles for abstract review. After abstract review, 50 articles were included for full text review. Six articles met inclusion criteria and were included in the final synthesis. The PRISMA flow diagram in Fig. 1 illustrates the article selection process. Three of the articles excluded during the full text review focused on early Play Streets efforts (1920s–1930s) and were therefore discussed in the background section of this paper to provide historic context. Results from current Play Streets efforts (n = 6) are presented as either a specific Play Streets intervention or a Play Streets-style intervention with temporary closure of a street or parking lot. Any articles detailing broader events, such as Ciclovías or Open Streets, that did not specifically mention incorporating an activity hub/area were excluded. Seven Ciclovía or Open Street events mentioned having activity hubs/areas (e.g., fitness classes, children’s activities, school games, etc.…) that could have included an area with active play opportunities for children or adolescents; however, none of these papers included enough detail to determine if this occurred, and were therefore also excluded from this review [24, 35‐40]. One of these studies also mentioned creating temporary park spaces from parking spots; however, these were not well-described and therefore the article was not included [37]. Additional articles were excluded if an intervention was not implemented, if children or adolescents were excluded, if the event was not temporary, and if the study was not offered in a modern timeframe. Intervention types meeting inclusion criteria were Play Streets (n = 4), a pop-up park (n = 1), and a mobile physical activity unit intervention (n = 1). Four of the six included studies used cross-sectional designs, and two used a pre-post test design (quasi-experimental and non-equivalent). Table 1 summarizes each study’s location, population, and intervention. Table 2 presents a detailed description of the measures and outcomes from each study, including outcomes for active play, physical activity, and neighborhood and community impacts. The following sections qualitatively describe impacts on opportunities for play, physical activity, and environment, separately identifying these for Play Streets and for Play Streets-style interventions.

As previously mentioned, all included studies were non-RCTs. In assessing the three Cochrane risk of bias features relevant for non-RCTs (incomplete outcome data, selective outcome reporting, and other potential sources of bias), two studies scored low risk across all three features [41, 42], two studies scored low in two features, but were unclear with regards to “incomplete outcome data” [17, 22], one study was assessed as unclear in all three features [43], and one study was assessed as unclear for “incomplete outcome data”, high risk of bias for “selective outcome reporting” due to a lack of data presented in the results, and high risk of bias for “other potential sources of bias” due to potential selection bias from differences in the two groups being compared [16] (see Table 3). Overall 55.5% of the risk of bias assessments were rated as low risk, 33.3% unclear, and 11.1% high risk.

Refereed literature documenting impacts of Play Streets and Play Streets-style interventions is limited. As shown in this review, most published studies describing the impacts of Play Streets or Play Streets-style interventions have been written from a general outcome evaluation perspective. Although these studies provide some evidence and support for Play Streets as a potentially effective approach to increase active play and physical activity in under resourced communities, there is a gap in knowledge regarding effective implementation and related impacts. Current evidence suggests that Play Streets are not only about increasing physical activity, but also about other important associations, having the potential to strengthen communities. This review identified six quasi-experimental studies assessing Play Streets, and although risk of bias was relatively low in over half of the risk assessments, physical activity and community outcomes were inconsistently and rarely measured across the studies, limiting conclusions to promising impacts and associations. The search process for this systematic literature review revealed that Play Streets are not new, with this systematic literature review revealing multiple purposes of current Play Streets. These include enhancing or improving safety; health; physical activity and active play opportunities for children, adolescents, and families; social cohesion; and community capacity. These current impacts are broader than the intended impacts of initial Play Streets, which was to reduce pedestrian fatalities from vehicles. Play Streets included in this review had notable social and emotional impacts on participants, including increased social interactions and positive feelings about participants’ communities. These findings suggest great potential for broader community impacts beyond the individual level. There is a lack of evidence regarding sustainability and the long-term benefits of Play Streets, economic costs, and more objectively measured environmental impacts, including air quality and community violence, as well as social cohesion. Future work should examine these areas and publish this information in the peer reviewed literature to help build this evidence base.

Emerging evidence from this systematic review suggest that Play Streets and Play Streets-style interventions have the potential to increase active play and physical activity opportunities for children and possibly adolescents, by providing usable space for recreation in close proximity to residents that would not be available or accessible otherwise. When measured, evidence demonstrates practically meaningful increases in physical activity levels during these events, even suggesting that children and adolescents may be more likely to meet physical activity guidelines by participating in Play Streets. However, despite this potential association, evidence is limited. Current evidence where physical activity is measured suggests that Play Streets might be more effective at increasing vigorous physical activity as compared to moderate levels of physical activity. Future work should further examine whether vigorous physical activity should be the focus of Play Streets, or if there are ways to incorporate additional activities to encourage both moderate and vigorous physical activity. While promising, more research is needed to determine if physical activity levels are higher on days when Play Streets occur versus days when they do not occur, if increases in physical activity levels during Play Streets are meaningful from a public health perspective, and if Play Streets are well suited for both children and adolescents. Future work should also consider working with adolescents in the community to identify activities that could be added to better engage adolescents in physical activity at Play Streets.

This review revealed that Play Streets and Play Streets-style interventions are popular and gaining momentum in urban communities, which raises questions about their implementation, utility, and feasibility in rural settings. People living in rural communities face unique obstacles to engaging in daily, routine physical activity, including dispersed land use, fewer walkable destinations, and scarcely available infrastructure, like parks and playgrounds where children and adolescents can engage in active play [44, 45]. As revealed by this review, there have been no published studies of Play Streets in rural settings, which is an area for future research. Moreover, very few studies described the race and ethnicity of the users of the Play Streets and Play Streets-style subcomponents, which also raises questions about implementing them in diverse communities. Based on the existing literature, it is unclear whether implementation teams actively sought input from diverse community members when designing the Play Streets. Future efforts should involve children, adolescents, and families in determining culturally appropriate activities when designing Play Streets.

Although standard and validated methods were utilized in many of the studies, specifically seen through systematic observations and validation checks, physical activity assessment often relied upon self-report measures or was absent. The heterogeneity of research methods used and/or information reported in the studies included in this review makes it challenging to fully understand the effects of Play Streets and Play Streets-style interventions. The bias risk assessment conducted and the types of study designs included provides some indication of the strength and quality of the research. Each of the included studies utilized analytic designs over more descriptive designs. Specifically, four of six included studies were cross-sectional designs, and two studies involved a pre-post test design (quasi experimental and nonequivalent), which were able to account for some important potential confounders. The variation in study design, measures, and reporting also make it challenging to compare results across studies. Future work needs to expand upon these methods to include objective, device-based, physical activity assessment in combination with the systematic observations and validation checks reported in current studies. Researchers and implementers should look to further examine effects on regular physical activity across Play Streets seasons using accelerometers to capture sedentary, moderate, and vigorous levels of physical activity. Play Streets researchers and evaluators should also report overall Play Streets attendance, sample size, and demographic information, specifically age, sex, and race/ethnicity, for Play Streets initiatives in addition to reporting this information for study participants. The heterogeneity of how this type of information was reported in current studies does not allow for a complete understanding of reach.

Although this systematic literature search was comprehensive and ranged across decades, inherent in any literature search is the possibility that relevant studies were missed. This is possible given inconsistencies in terms describing Play Streets and broader events with Play Streets-style subcomponents. Although we included a wide range of terms to minimize this possibility, we could have missed other studies using unique names/identifiers of events that would have met our inclusion criteria. Also, while it is possible that broader street events, like Open Streets and Ciclovías, could include a Play Streets-style component as part of an activity hub/area, current literature does not provide enough detail to determine if this is happening, even when an article mentions that activity hubs were included as part of an Open Street or Ciclovía event. In addition, possible Play Street components that are part of larger events such as Open Streets/Ciclovías could have some differences in processes and resources needed to implement them; the social, environmental, and behavioral outcomes may be somewhat different as well. Future work should attempt to understand if Open Street and/or Ciclovía events include Play Streets-style components as part of the broader event and how these operate within this context. In addition, we did not include events where streets or parking lots were not completely closed off to traffic [46, 47]. Although we were intentional in not including these studies, there could have been some useful information around interventions strategies that was missed due to this exclusion. It is also possible that there are enhanced types of joint-use agreement interventions, [48] and interventions that specifically recruited participants for open play space events, [42] that were not included in this review that could contain information useful to developing Play Streets interventions.

We also acknowledge the potential for publication bias, as manuscripts unavailable in English were excluded. Publication bias may have also resulted from our decision to exclude studies from the grey literature, which if included could have increased the sample of articles and might have provided useful information about implementation and sustainability given that Play Streets have been implemented in dozens of cities globally such as Kensington and Victoria in Melbourne, Australia; Edinburgh, Scotland; Hackney, U.K.; Chicago, Illinois and New York City, NY in the U.S.. However, these articles were excluded because this review was focused on documenting impacts of Play Streets, which based on our initial review of the articles found from our search strategy, we felt would be in the scientific literature.

This review fills an important gap in our understanding of Play Streets and other temporary Play Streets-style interventions as accessible intervention strategies for increasing physical activity opportunities for children and adolescents. As evidenced in this review, there is limited refereed literature describing how Play Streets impact active play, physical activity, and neighborhood and community outcomes, and even less literature describing implementation of Play Streets and Play Streets-style interventions. Although there is strength in current methods being used within the general outcome evaluations of the events reviewed here, there is a need to better understand planning and implementation procedures, specifically for Play Streets.

To advance scholarship regarding the implementation and impacts of Play Streets, future studies could explore the grey literature and conduct in-depth interviews with current and previous Play Streets’ implementers and participants to better understand implementation procedures. Future research should also go beyond descriptive and self-report measures. In addition, the following concepts should be included to help document and assess community impact of Play Streets: safety, social cohesion, implementation costs, social engagement, and sustainability. The following should be considered in study design: implementation measures, use, controlling for potential confounding factors, and systematically observed and device-based measured physical activity during Play Streets and non-Play Streets weeks, as well as how an entire Play Streets season impacts child and adolescent physical activity. Future work needs to further examine planning and implementation procedures of Play Streets and examine how Play Streets could be adapted for implementation in non-metropolitan, small town, and rural settings, and for diverse communities.

Play Streets hold promise as an effective strategy to strengthen communities and increase active play and physical activity by providing a safe and accessible space within communities. Given this promising evidence of increased physical activity rates reported across several studies, future work is needed to confirm these findings in different types of communities and to understand the barriers and facilitators to successful implementation.