Air Pollution-Driven Parental Restrictions: Associations with Children’s Active School Transport in Urban and Rural India

Abstract

Active school transportation (AST), including walking or cycling to school, is common among children and youth in India. However, rising air pollution and public health advisories may encourage parents to restrict outdoor activities. The role of parental restrictions on children’s and youths’ participation in AST remains largely unexplored. This study examines how parental restrictions on outdoor activity influence children’s and youths’ engagement in AST. We surveyed children and youth aged 5 to 17 from 41 schools across 28 urban and rural locations in five Indian states, collecting data on AST, parental restrictions, perceptions of air pollution, sociodemographic factors, and school distance. Data were analyzed using multiple logistic regression models, adjusted and unadjusted for children’s and youths’ perceptions of air pollution, segregated by age, gender, and location. Reported parental restrictions due to air pollution were associated with lower odds of engaging in AST overall (OR = 0.625, 95% CI = 0.400–0.971), for ages 5–12 (OR = 0.460, 95% CI = 0.208–0.985, and in urban areas (OR = 0.433, 95% CI = 0.198–0.881). Adjusting for children’s and youths’ air pollution perceptions, these associations persisted in overall and urban analyses. Living over 2 kilometres from school also lowered odds of AST participation (p < 0.05 across all models). The interplay between AST, air pollution, and parental restrictions is self-reinforcing: air pollution can trigger parents to restrict child and youth mobility and reduce AST and, in turn, lower AST may contribute to worsening air quality because of increased motorized transport. Integrated policies are required to simultaneously mitigate pollution and enhance active transportation infrastructure.

1. Introduction

Non-communicable diseases (NCDs), such as cardiovascular disease, obesity, and type 2 diabetes, account for over 74% of global deaths (Noncommunicable Diseases, n.d.). Low- and middle-income countries, including India, are disproportionately impacted by the NCD burden, with 86% of premature NCD-related fatalities occurring in these regions (Noncommunicable Diseases, n.d.). In India, rapid urbanization and population growth have contributed to NCDs overtaking infectious diseases as the leading cause of mortality (Anjana et al., 2023; Kaur et al., 2022; Sharma et al., 2024a). Given that many lifestyle behaviours linked to NCD risk develop in childhood (Bander et al., 2023; Investing in Our Future, 2021; Tohi et al., 2022), and that many NCDs are preventable (Budreviciute et al., 2020; Lancet, 2025; Non Communicable Diseases|NCD Alliance, n.d.), it is imperative to address modifiable risk factors, such as physical activity (Ding et al., 2016; Katzmarzyk et al., 2022; I.-M. Lee et al., 2012), a nutrient-rich diet (Borle et al., 2022; Krishnaswamy & Vaidya, 2016), and adequate sleep (Dong et al., 2019; Gomes et al., 2023), among children and youth.

Among these factors, physical inactivity is a major concern, ranking as the fourth leading cause of premature mortality globally (NCDs, n.d.). Physical inactivity disrupts metabolic (Kallio et al., 2018; N. R. Kerr & Booth, 2022), cardiovascular (Alvarez et al., 2019; Canabrava et al., 2019), muscular (Aktürk et al., 2019; Bogdanis, 2012), and immune functions (Merlin et al., 2020; Shao et al., 2021). In children and youth, regular physical activity supports growth (Fritz et al., 2016; Janssen & LeBlanc, 2010), cognitive and motor skill development (Shi & Feng, 2022; van der Fels et al., 2020), and mental health (Cai et al., 2025; Li et al., 2023), while also reducing the risk of early-onset chronic conditions (Saraf et al., 2012; Swaminathan & Vaz, 2013). However, nearly half of children and youth in India do not meet the World Health Organization’s (WHO) recommended daily average of moderate-to-vigorous physical activity (MVPA) (i.e., 60 min) (Bhawra et al., 2018; Bhawra et al., 2023a; Katapally et al., 2016; WHO Guidelines on Physical Activity and Sedentary Behaviour, 2020). This underscores the need for accessible and sustainable strategies to promote physical activity among children and youth in India.

Active school transportation (AST), which involves walking or biking to school, presents a promising approach to promote physical activity (Larouche et al., 2014, 2018; Prince et al., 2022; Schoeppe et al., 2013; Smith et al., 2015). AST is a prevalent practice in India, earning the highest grade (B−) among all evaluated indicators in the 2022 India Report Card on Physical Activity for Children and Adolescents (Bhawra et al., 2023a). Unlike structured sports programs or recreational facilities, AST offers a practical and sustainable way to integrate physical activity into daily routines without requiring additional resources (González et al., 2020; C. Lee & Li, 2014; Prince et al., 2022; Scharoun Benson et al., 2020; Smith et al., 2015). In addition to individual health benefits (Ding et al., 2024; Dinu et al., 2019), AST contributes to public health and environmental improvements by reducing reliance on motorized transport, thereby lowering traffic congestion and vehicular carbon emissions, and contributing to improved air quality (Brand et al., 2021; Burbidge & Goulias, 2009; Cycling and Walking Can Help Reduce Physical Inactivity and Air Pollution, Save Lives and Mitigate Climate Change, 2022; Ding et al., 2024; Mun Ng et al., 2024; Neves & Brand, 2019).

These considerations are especially relevant in the context of India’s rapidly urbanizing landscape. As of 2023, more than one-third of India’s population resides in urban areas—a rise of approximately 4% over the past decade (India—Urbanization 2023, 2025). In many cities, urban sprawl, a phenomenon describing the spread of urban development into peripheral areas (Sharma et al., 2024b), typically in a low-density and uncoordinated manner, has widened the spatial gap between residential neighbourhoods and schools. Larger institutions, such as private and public schools affiliated with the Central Board of Secondary Education, often require extensive sites to accommodate their infrastructure needs (e.g., laboratories, libraries, and sports facilities) and are thus often established in suburban areas (Reddy & Pasupuleti, 2024). The resulting longer home-to-school travel distances can limit the feasibility of active transport (Tetali et al., 2016; Wong et al., 2011) and contribute to increased motor-vehicle traffic along school routes, potentially traffic-related emissions and intensifying parental concerns about children’s exposure to poor air quality (Air Quality Consultants—Case Study—School Streets, 2021; National Study on Safe Commute to School, 2021; Waters et al., 2021).

While infrastructural and urban planning factors shape access to AST, several socioecological factors limit the adoption of AST among children and youth (Adlakha & Parra, 2020; Bhawra et al., 2023b; Kingsly et al., 2020; Larouche et al., 2015; Patel et al., 2024; Tarun et al., 2017), with air pollution being a key barrier in India (Anjum et al., 2024; Climate Trends, n.d.; Jaganathan et al., 2025). India’s air quality frequently exceeds WHO safety guidelines (Air Pollution—India, n.d.; India, 2023; Jaganathan et al., 2025), posing serious health risks, particularly for children and youth. These populations’ developing respiratory systems (Tran et al., 2023; Ziou et al., 2022), and weaker immune defenses (Prunicki et al., 2021) make them more vulnerable to air pollutants. Prolonged or high-level exposure can impair lung function (Götschi et al., 2008), increase the risk of cardiovascular disease and stroke (Babadjouni et al., 2017), and exacerbate asthma symptoms (Tiotiu et al., 2020).

Concerns about air pollution can influence parental decisions regarding outdoor activities; when parents perceive environmental risks, they often adopt avoidance behaviours, restricting children’s outdoor mobility to minimize exposure (Chandwania & Natu, 2022; Faulkner et al., 2015; Oliver et al., 2022; Tan-Soo et al., 2018; Tappe et al., 2013; Waters et al., 2021). While limiting outdoor exposure may reduce immediate health risks, it may also contribute to physical inactivity (Bhawra et al., 2023b; Joo et al., 2021; Patel et al., 2024; Yu & Zhang, 2023). In particular, providing children and youth in India access to outdoor physical activity facilities before or after school is associated with lower sedentary behaviour (Sandhu et al., 2025). Since AST is a major source of MVPA for children and youth (Denstel et al., 2015; Katapally et al., 2024), avoiding outdoor activities due to air pollution concerns could have unintended health consequences (Poitras et al., 2016).

Research on parental perceptions of air pollution and children’s mobility has largely been conducted in high-income countries such as the United States, China, and countries in Europe (Liu & Salvo, 2018; Maddren et al., 2025; Mitra et al., 2014). However, findings from these contexts have been mixed. Although some studies have documented parental behavioural changes in response to perceived environmental risks, others have found minimal adjustments—particularly in relation to children’s and youths’ outdoor activity. For example, one USA study involving children with persistent asthma found that few parents adjusted their children’s outdoor activities in response to perceived poor air quality or formal air quality index alerts (Reyes-Angel et al., 2022). In contrast, results from a national USA survey indicated that over two-thirds of parents reported restricting their children’s time outdoors when air quality was poor (Protecting Children from Poor Air Quality, 2023). In India, while several region-specific studies have investigated examined parental influences on children’s mobility broadly (Kingsly et al., 2020; Tetali et al., 2016; Tyagi & Raheja, 2021a, 2021b), few have specifically focused on AST. One study conducted in Chennai found that adolescents aged 12–17 were 82% less likely to engage in AST when their parents did not permit it perceived the school as being too far away (Kingsly et al., 2020). However, this study did not examine air pollution as a motivating factor behind parental restrictions on AST.

Moreover, findings from other countries on air pollution-related parental restrictions on AST may not be directly applicable to India, which has distinct cultural, infrastructural, and environmental conditions (Bhawra et al., 2023b; Kingsly et al., 2020; Larouche et al., 2015; Patel et al., 2024). India faces some of the world’s worst air quality, with fine particulate air pollution shortening the average individual’s life expectancy by 5.3 years (India, 2023). Yet, how parents in India, as key decision-makers in their children’s daily routines, respond to air pollution and influence their children’s participation in AST remains largely unexplored.

Thus, this study aimed to examine how parental restrictions on outdoor activity are associated with the odds of children and youth engaging in AST. The secondary objective was to examine how the relationship between parental restrictions on AST varies across different sociodemographic groups (age, location, and gender). Given the perceived health risks associated with poor air quality, we hypothesized that children and youth whose parents restricted their outdoor activities would have lower odds of engaging in AST. As perceptions are shaped by personal experiences, environmental conditions, media exposure, and sociocultural norms (Aranda-Balboa et al., 2020; Kingsly et al., 2020; Murukutla et al., 2017), we also hypothesized that there would be variation in parental restrictions and associations with AST across different demographic and geographic groups.

2. Methods

2.1. Design

This cross-sectional observational study was conducted in 2021 in India, during the Coronavirus disease (COVID-19) pandemic lockdown as part of a larger multi-centre cohort study spanning five Indian states (Maharashtra, Gujarat, Telangana, Madhya Pradesh, and Tamil Nadu). The study population consisted of children and youth aged 5 to 17 years from 28 cities and villages (urban and rural regions). A multistage, stratified random sampling method was used to collect data from participants through an online survey. Data on parental restrictions on outdoor activity, children’s and youths’ perceptions of air pollution, various sociodemographic characteristics, and distance from home to school were collected. The Ethics Committee of Jehangir Clinical Development Centre Pvt. Ltd., Pune, Maharashtra (EC registration number—ECR/352/Inst/MH/2013/RR-19), granted ethical approval for this study.

2.2. Study Recruitment and Participants

To apply the multistage stratified random sampling method, first, cities (i.e., urban) and nearby villages (i.e., rural) were randomly selected. Next, a list of schools from each of these locations was generated and principals of these schools were contacted with study information. In total, 41/50 selected schools’ principals provided permission for their respective schools to be recruited. Study information and consent forms were electronically distributed to students attending each school, and their parents. Following the receipt of informed consent forms from parents and assent forms from students, the survey, which was created on Google Forms, was sent out to children and youth and available to answer between 15 March and 20 May 2021. The surveys were completed individually and anonymously, with children under 13 years of age receiving parental and/or guardian guidance. The survey asked participants to respond to a series of questions covering sociodemographic characteristics, active living behaviours, such as active transportation, physical activity, and sedentary behaviour, as well as their perceptions of the physical and built environments, including community, built environment, and air pollution.

2.3. Measures

2.3.1. Sociodemographic Characteristics

Sociodemographic questions included in the survey pertained to participants’ age, gender, and geographic location. By collecting individuals’ date of birth, participants’ ages were classified and sorted into one of the two following categories: “child” (5–12 years) or “youth” (13–17 years). Participants’ gender was determined by asking whether they identified as “male” or “female.” With 41 schools participating in the study, geographic location was determined by categorizing the schools as either rural or urban, based on their proximity to population centers. The full list of survey questions can be found in Questionnaire S1.

2.3.2. Active Transportation

Engagement in active transportation was assessed by asking children and youth about their mode of transportation to school. “Do you bike to school?” and “Do you walk to school?” were the two survey questions pertaining to AST, with “yes” or “no” response options. To connect these responses to engagement in AST, participants who responded “yes” to either biking or walking was classified as “yes” to AST engagement.

2.3.3. Children’s and Youths’ Perceptions of Air Pollution

Children’s and youths’ perceptions of air pollution were measured by their responses to the statement, “There is an air pollution problem in my city/village”. Participants rated their level of agreement on a 5-point Likert scale (strongly disagree, disagree, neither agree nor disagree, agree, strongly agree). Responses were then dichotomized into two categories: disagree (strongly disagree, disagree) and agree (strongly agree, agree). Neutral responses were treated as missing.

2.3.4. Parental Restrictions

To collect information on parental restrictions imposed on children and youth, participants were asked to respond to the following statement: “My parents restrict my outdoor activities because of air pollution”. Participants rated their level of agreement on a 5-point Likert scale (strongly disagree, disagree, neither agree nor disagree, agree, strongly agree). Responses were then dichotomized into two categories: disagree (strongly disagree, disagree) and agree (strongly agree, agree). Neutral responses were treated as missing.

2.3.5. Distance from Home to School

To assess the distance between participants’ residences and schools, participants were asked “To the best of your knowledge, how far is your school from home”, with the following response categories: “Less than 2 km”, “Less than 5 km”, “Less than 10 km”, “Less than 20 km”, and “More than 20 km”. The response was dichotomized into “Less than 5 km”, which corresponds to “Less than 2 km” and “Less than 5 km”, and “5 km or more”, which corresponds to “Less than 10 km”, “Less than 20 km”, and “More than 20 km”.

2.3.6. Presence of Footpaths in the Neighbourhood

Information on neighbourhood walking infrastructure was collected by assessing participants’ perceptions of footpath availability in their neighbourhood. Participants responded to the statement, “There are footpaths on most of the streets in my neighbourhood”, rating their agreement on a 5-point Likert scale (strongly disagree, disagree, neither agree nor disagree, agree, strongly agree). Responses were then dichotomized into two categories: disagree (strongly disagree, disagree) and agree (strongly agree, agree). Neutral responses were treated as missing.

2.4. Statistical Analysis

The primary independent variable for this study was parental restriction on outdoor activity imposed on children and youth due to air pollution, as reported by children and youth, and the dependent variable was children’s and youths’ engagement in AST. As the outcome variable was dichotomous (yes or no responses), logistic regression, a statistical method used for analyzing relationships with dichotomous outcome variables, was performed. Two sets of models were generated: one without adjustment for children’s and youths’ perceptions of air pollution (base model), and one adjusted for these perceptions (adjusted model). Each set comprised seven models, stratified by gender (male and female), age group (5 to 12 years and 13 to 17 years), and location (urban and rural). In both sets of models, the overall model, which included all independent variables, and the age-specific models, were adjusted for gender and location. The gender-specific models were adjusted for age and location, and the location-specific models were adjusted for gender and age. Sensitivity analyses were conducted to further explore the associations found in the primary models (Tables S2 and S3). The results of this study were considered statistically significant if the p-value was below 0.05. For all items measured on a 5-point Likert scale, responses of “neither agree nor disagree” were treated as missing values. This approach was used to minimize interpretive ambiguity associated with neutral responses and to prevent them from obscuring the direction of associations estimated in the regression models.

3. Results

A total of 1042 children and youth participated in the study. Among them, 992 met the eligibility criteria (aged 5 to 17) and were included in the analyses.

Table 1. Baseline characteristics of children and youth (N = 992).

Dependent Variable
	N	%
Active School Transportation
Yes	337	34.0
No	654	66.0
Independent Variables
Age Group
5 to 12 years	547	55.1
13 to 17 years	445	44.9
Gender
Male	499	50.3
Female	493	49.7
Location
Rural	400	40.3
Urban	592	59.7
Parental Restrictions on Outdoor Activity due to Air Pollution
Agree	242	27.5
Disagree	637	72.5
Perception of Air Pollution
Agree	528	59.2
Disagree	364	40.8
School Distance
2 km or less	474	47.8
More than 2 km	517	52.2
Footpath Presence on Neighbourhood Streets
Agree	556	60.9
Disagree	357	39.1

outlines the baseline characteristics of the participants. The sample was composed of 55.1% children aged 5 to 12 years and 44.9% adolescents aged 13 to 17 years. In terms of gender, 50.3% of the participants were male, and 49.7% were female. Geographically, 40.3% of participants lived in rural areas, while 59.7% resided in urban areas. Regarding parental restrictions due to air pollution, 27.5% of participants reported that their parents restricted outdoor activities, while 72.5% disagreed. As for perceptions of air pollution, 59.2% of children and youth agreed that air pollution was a problem, while 40.8% disagreed. In terms of school distance, 47.8% of participants had schools within 2 km of their home, while 52.2% had schools located more than 2 km away.

Table 2. Comparison of parental restrictions on outdoor activity due to air pollution among children and youth, across sociodemographic cohorts.

Strata	Category	Parental Restrictions		χ2 (p Value)	Air Pollution Perceptions		χ2 (p Value)
Strata	Category	Agree (%)	Disagree (%)		Agree (%)	Disagree (%)
Gender	Male	114(25.5)	334 (74.5)	1.783 (p = 0.182)	269 (58.4)	192 (41.6)	0.212 (p = 0.645)
	Female	128 (29.7)	303 (70.3)		259 (60.1)	172 (39.9)
Age group	5–12	78 (25.9)	223 (74.1)	0.483 (p = 0.487)	198 (63.7)	113 (36.3)	3.675 (p = 0.055)
	13 to 17	164 (28.4)	414 (71.6)		330 (56.8)	251(43.2)
Location	Rural	109 (28.3)	276 (71.7)	0.145 (p = 0.703)	162 (41.1)	232 (58.9)	94.1 (p < 0.000)
	Urban	133 (26.9)	361 (73.1)		366 (73.5)	132 (26.5)

compares parental restrictions on outdoor activity due to air pollution and perceptions of air pollution across sociodemographic cohorts. Among males, 25.5% agreed with parental restrictions, while 74.5% disagreed. For females, 29.7% agreed, with 70.3% disagreeing. In terms of air pollution perceptions, 58.4% of males and 60.1% of females viewed air pollution as a problem, while 41.6% and 39.9%, respectively, did not. Looking at age groups, 25.9% of children aged 5–12 years agreed with parental restrictions, compared to 28.4% of adolescents aged 13–17. Regarding perceptions of air pollution, 63.7% of children recognized air pollution as a problem, while 56.8% of adolescents shared this view. In rural areas, 28.3% of children and youth agreed with parental restrictions, while 71.7% disagreed. In urban areas, 26.9% agreed, with 73.1% disagreeing. Perceptions of air pollution showed a stark contrast: 41.1% of rural residents saw it as a problem, whereas 73.5% of urban residents did, with this difference being statistically significant (χ² = 94.1, p < 0.000).

The logistic regression models presented in

Table 3. Logistic regression models examining the association between parental restrictions on outdoor activity due to air pollution and active school transportation.

Outcome Variable—Active School Transport: Yes
Odds Ratio (95% Confidence Intervals) Ω
		Overall	Age Group		Gender		Location
			5–12	13–17	Male	Female	Urban	Rural
Baseline	Parental restrictions: Agree	0.625 * (0.400, 0.971)	0.460 * (0.208, 0.985)	0.875 (0.490, 1.559)	0.592 (0.326, 1.059)	0.717 (0.354, 1.439)	0.433 * (0.198, 0.881)	0.952 (0.510, 1.811)
	Distance from home to school > 2 km	0.078 * (0.050, 0.120)	0.091 * (0.041, 0.187)	0.079 * (0.045, 0.136)	0.107 * (0.062, 0.180)	0.045 * (0.019, 0.096)	0.136 * (0.072, 0.247)	0.049 * (0.025, 0.092)
	Footpath presence on neighbourhood streets: Disagree	1.678 * (1.103, 2.544)	1.729 (0.854, 3.423)	1.685 (0.964, 2.961)	1.445 (0.829, 2.504)	2.076 * (1.068, 4.015)	1.124 (0.547, 2.218)	2.137 * (1.213, 3.784)
	N	828	452	376	427	401	449	379
Adjusted	Parental restrictions: Agree	0.591 * (0.357, 0.969)	0.569 (0.240, 1.298)	0.657 (0.332, 1.285)	0.613 (0.313, 1.178)	0.645 (0.288, 1.423)	0.367 * (0.157, 0.792)	0.895 (0.405, 2.001)
	Distance from home to school > 2 km	0.076 * (0.048, 0.117)	0.091 * (0.040, 0.188)	0.074 * (0.040, 0.131)	0.105 * (0.060, 0.178)	0.042 * (0.017, 0.092)	0.128 * (0.065, 0.241)	0.049 * (0.025, 0.091)
	Children’s and youths’ perceptions of air pollution as a problem: Disagree	0.956 (0.603, 1.499)	1.648 (0.787, 3.358)	0.550 (0.289, 1.022)	1.165 (0.640, 2.093)	0.776 (0.362, 1.600)	0.966 (0.471, 1.923)	0.853 (0.414, 1.709)
	Footpath presence on neighbourhood streets: Disagree	1.573* (1.018, 2.422)	1.545 (0.740, 3.137)	1.650 (0.920, 2.977)	1.323 (0.741, 2.344)	2.009* (1.005, 3.991)	0.944 (0.451, 2.090)	2.108* (1.191, 3.745)
	N	773	422	351	406	367	397	371

* Indicates statistically significant association at p < 0.05. ^Ω This model controlled for age, gender, and location.

assess the association between parental restrictions on outdoor activity due to air pollution and AST across different age groups, genders, and locations. In the baseline model, parental restrictions on outdoor activity was significantly associated with lower odds of AST overall (OR = 0.625, 95% CI: 0.400, 0.971). Significant associations were also observed in the 5–12 age group (OR = 0.460, 95% CI: 0.208, 0.985) and for those living in urban areas (OR = 0.433, 95% CI: 0.198, 0.881). However, no significant associations were observed in the 13–17 age group, or among male and female subgroups.

Residing more than 2 km from school was consistently associated with lower odds of AST across all subgroups. The strongest associations were observed for females (OR = 0.045, 95% CI: 0.019, 0.096), and for those living in rural areas (OR = 0.049, 95% CI: 0.025, 0.092).

Disagreement with the statement “There are footpaths on most of the streets in my neighbourhood” was significantly associated with greater odds of AST overall (OR = 1.678, 95% CI: 1.103, 2.544), for females (OR = 2.076, 95% CI: 1.068, 4.015), and for those living in rural areas (OR = 2.137, CI: 1.213, 3.784).

In the adjusted model, parental restrictions remained significantly associated with lower odds of AST overall (OR = 0.591, 95% CI: 0.357, 0.969), and for those living in urban areas (OR = 0.367, 95% CI: 0.157, 0.792). No significant associations were observed in the age-specific or gender-specific models.

Residing more than 2 km from school was consistently associated with lower odds of AST across all subgroups. The strongest associations were observed for females (OR = 0.042, 95% CI: 0.017, 0.092) and for those living in rural areas (OR = 0.049, 95% CI: 0.025, 0.091).

Disagreement with the statement “There are footpaths on most of the streets in my neighbourhood” was significantly associated with greater odds of AST overall (OR = 1.573, 95% CI: 1.018, 2.422), for females (OR = 2.009, 95% CI: 1.005, 3.991), and for those living in rural areas (OR = 2.108, 95% CI: 1.191, 3.745).

As part of the sensitivity analyses, we first adjusted for sociodemographic characteristics and then conducted univariate logistic regression models (Table S2). Parental restriction on outdoor activity was significantly associated with lower odds of AST across all models, with the exception of the 13–17 age group, and for children and youth living in urban regions. We then extended the models to adjust for additional contextual factors reflecting children’s and youths’ neighbourhood environments, including features of the neighbourhood community and built environment: the presence of attractive natural sightings, street trees, zebra crossings and pedestrian signals, footpaths, perceived neighbourhood crime rate, and the perception of neighbourhood traffic as a barrier to walking. After accounting for these factors, the negative association between parental restrictions due to air pollution and odds of AST persisted, however, was no longer statistically significant (Table S3).

4. Discussion

4.1. Active School Transportation Among Children and Youth in India

AST serves as a key contributor to child and youth physical activity (Denstel et al., 2015), particularly in low-to-middle income countries like India (Katapally et al., 2024). AST may also contribute to reducing air pollution levels by decreasing reliance on motorized transportation for school commutes (Frank et al., 2010; Glazener & Khreis, 2019; Haines et al., 2009). However, rising air pollution levels may negatively impact parents’ perceptions of air pollution, potentially leading them to restrict their children’s and youths’ engagement in AST (Liu & Salvo, 2018; Maddren et al., 2025; Mitra et al., 2014). Previous research has focused on how children and youth in India perceive air pollution’s impact on AST, but the role of parents in shaping these behaviours remains unexplored (Bhawra et al., 2023b). Studies exploring how parental perceptions of air quality affect their decisions regarding children’s activities, primarily conducted in high-income countries (Liu & Salvo, 2018; Maddren et al., 2025; Mitra et al., 2014), do not fully capture the dynamics in the Global South, including India, where unique environmental and socioeconomic factors play a significant role (Bhawra et al., 2023b; Kingsly et al., 2020; Patel et al., 2024).

4.2. Parental Restrictions Due to Air Pollution Decrease AST Likelihood Overall

Our study revealed that children and youth whose parents restricted their outdoor activity due to air pollution were less likely to engage in AST. This association aligns with a study conducted in Utah by Waters et al. (2021), in which caregivers of cancer survivors limited family outdoor activities due to their negative perceptions about air pollution (Waters et al., 2021). Numerous studies conducted in India have found that parental perceptions of environmental and safety risks influence their decisions about their children’s independent mobility (CIM) (Lin et al., 2017; Tyagi & Raheja, 2021b, 2021a). These studies highlight two patterns: exposure reduction behaviours (McCarron et al., 2023), where parents actively modify their children’s environments or routines to reduce their exposure to perceived dangers, and risk avoidance behaviours (Tan-Soo et al., 2018), where they completely restrict their children’s participation in activities deemed risky. For instance, a Delhi case study conducted by Tyagi and Raheja (2021a) revealed that parental concerns about safety risks associated with specific locations—such as vehicular traffic around the neighbourhood market and stranger danger in the Delhi Metro public transport system—lead them to restrict children’s independent mobility, with 90% of parents interviewed preferring constant supervision of their children during travel (Tyagi & Raheja, 2021a). Further, Tyagi and Raheja (2021b) conducted a case study in an urban neighbourhood in Delhi, reporting that 70% of parents only allowed their children to bike or walk to the neighbourhood park in the evenings when other residents were also outside, thus enabling indirect supervision (Tyagi & Raheja, 2021b). With public awareness of air pollution increasing and levels consistently exceeding WHO guidelines (Air Pollution—India, n.d.; India, 2023; Jaganathan et al., 2025), parents may restrict their children’s outdoor activities, including active AST, to minimize their exposure to harmful pollutants. Future research should investigate the interplay between parental perceptions of air pollution and the built environment to understand how multiple environmental concerns collectively shape restrictions on children’s outdoor activity. Such exploration may reveal how factors such as green space availability, traffic density, and neighbourhood environment influence parental perceptions of air quality, potentially informing the development of targeted public health policies.

4.3. Parental Restrictions Due to Air Pollution Decrease AST Likelihood Among Children and Youth Aged 5–12

Our study also highlighted nuanced associations between parental restrictions across different sociodemographic groups, while also accounting for children’s and youths’ perceptions of air pollution. This approach enabled us to explore how both parental concerns and children’s and youths’ own views contribute to differences in AST engagement across various demographic cohorts. When assessing age-related patterns, we found that when we did not control for children’s and youths’ perceptions of air pollution, children aged 5 to 12 whose parents restricted AST due to air pollution were less likely to engage in AST. This finding is in line with the existing literature indicating that older youth, who are typically granted more autonomy, show greater independent mobility (Chandwania & Natu, 2022; Ferreira et al., 2024). For instance, a study in Hyderabad by Tetali et al. (2016) revealed that 8th graders were twice as likely to bike to school as 6th graders (Tetali et al., 2016). However, since this study focused on a narrow age range of 11–14 years, its findings may not fully apply to our broader study group of 5–17 years, where physical, cognitive, and developmental differences among children may influence their independent mobility (Riazi et al., 2022). Younger children, who are more vulnerable to environmental hazards like air pollution and road safety risks, may often face stricter parental restrictions. Conversely, older children are likely to have better-developed safety awareness and decision-making skills and thus may be perceived as better equipped to navigate their commutes independently (Riazi et al., 2022).

4.4. No Association Between Parental Restrictions and AST Among Children and Youth Aged 5–12 After Adjustment

However, after adding child and youth perceptions of air pollution as a problem to the model, the association between parental restrictions on outdoor activity and AST in 5- to 12-year-olds became non-significant. Although these perceptions were not significantly associated with AST, their inclusion in the model may have explained some of the variation previously attributed to parental restrictions. This suggests that unmeasured contextual factors, including neighbourhood crime, built environment characteristics, and socioeconomic status, may interact with parental and child perceptions of air pollution, influencing their views on the safety and desirability of AST (Aranda-Balboa et al., 2020; Bhawra et al., 2023b; Ikeda et al., 2018a). Such interactions may influence parental restrictions on outdoor activity due to air pollution perceptions, as well as children’s engagement in AST, potentially influencing the observed relationship. To unpack these complex relationships and identify priority areas for AST interventions, future studies can employ mixed methods approaches to examine the distinct and combined effects of parental and child perceptions on AST engagement. Surveys and focus groups can be used to independently assess the contextual factors shaping safety perceptions among parents and children, and quantitative methods such as mediation analysis could help determine the relative contribution of parental and child perceptions to AST engagement.

4.5. Parental Restrictions Due to Air Pollution Decrease AST Likelihood in Urban Regions

By examining how parental restrictions and AST engagement vary between locations (urban vs. rural), our study provides insights into how environmental context shapes mobility behaviours. Our findings show that in urban regions of India, children whose outdoor activities were restricted by parents due to air pollution perceptions were less likely to engage in AST. This observation aligns with the existing literature which suggests that parental concerns about air pollution are more pronounced in urban areas compared to rural ones, likely due to higher pollution levels, greater and visible exposure to vehicular and industrial emissions, and increased public awareness of air quality and its health impacts in urban regions (George et al., 2024; Guttikunda et al., 2014; India Air Quality Index (AQI) and Air Pollution Information|IQAir, n.d.; Tyagi & Raheja, 2021a; Yang, 2020). The 2022 India Report Card on Physical Activity for Children and Adolescents notes that from 2018 to 2022, urban infrastructure, including inadequate pedestrian facilities, such as footpaths and zebra crossings, received a ‘D’ grade for supporting AST (Bhawra et al., 2023a). Additionally, rapid urbanization, which involves housing and infrastructure expansion to support India’s urban population that has increased six-fold since 1960 (Urban Population—India, n.d.), has reduced available green spaces (Bherwani et al., 2021; Ramaiah & Avtar, 2019), and led to more densely populated areas (Srivastava et al., 2025). These changes have resulted in neighbourhoods which are less conducive to physical activity (Adlakha et al., 2016; Anjana et al., 2014; Boakye et al., 2023). Such changes in children’s and youths’ neighbourhood built environments may increase parents’ perceived safety challenges for children engaging in AST, as their routes may frequently cross major intersections and congested areas (Kingsly et al., 2020; Tyagi & Raheja, 2021a). Previous studies conducted in countries where air quality currently meets WHO guidelines, such as New Zealand (Ikeda et al., 2018b) and the United States (Kontou et al., 2020), revealed positive associations between the presence of urban characteristics such as population and intersection density and children’s and youths’ AST engagement. This suggests that in environments with good air quality, higher residential density and well-connected intersections may be perceived as convenient and safe, thus promoting AST among children. In contrast, in regions with poor air quality, such as India, the same urban attributes may be perceived differently, reinforcing the context-specificity of AST correlates across diverse urban regions (Larouche et al., 2015; McGrath et al., 2015). Evidence from India indicates that high population density is associated with increased pollution exposure (Gurjar et al., 2016), and that poor street connectivity (Tyagi & Raheja, 2021b) may amplify parental concerns regarding traffic safety (Kingsly et al., 2020; Tyagi & Raheja, 2021a, 2021b). Experiencing these conditions could adversely influence parental perceptions of air quality (Guo et al., 2016), potentially leading to stricter restrictions on children’s outdoor activity. Future longitudinal studies can explore how varying air quality conditions affect perceptions of the built environment in urban regions, and whether both short- and long-term improvements in air quality influence parental restrictions.

4.6. Residential Distance > 2 km from School Decreases AST Likelihood

India’s rapid urban development has often positioned schools further from residential areas, creating distance-related barriers that limit AST participation. Our study found that children living more than 2 km from school were less likely to use AST, a finding supported by existing research that recognizes distance as a crucial factor in active transportation (Aranda-Balboa et al., 2020; Kingsly et al., 2020; Tetali et al., 2016). A review by Aranda-Balboa et al. (2020) found that distance to school was the strongest barrier to AST, noting that parents are more likely to permit their children to engage in AST for short travel distances (Aranda-Balboa et al., 2020). Parents may be more inclined to allow independent travel for short distances due to safety risks, including air pollution exposure, crime, and traffic congestion, becoming more significant with longer commutes (Nelson et al., 2008; Tetali et al., 2016). Consequently, to minimize exposure to environmental pollutants during longer commutes, parents may prefer motorized transportation over AST. Supporting this, a study by Rodrigues et al. in Portugal found that children whose mothers reported traveling to work in a passive way had significantly lower odds of AST compared to children whose mothers were active commuters (Rodrigues et al., 2018). In LMICs like India, where independent mobility is often restricted due to safety concerns (Lin et al., 2017; Tyagi & Raheja, 2021a, 2021b), parents may only permit AST when accompanying their children. Given these constraints, factors such as time, availability, and the ease of coordinating travel with parental work schedules may be critical determinants of whether their children engage in AST (Lucken et al., 2018; Yarlagadda & Srinivasan, 2007). Furthermore, children’s own perceptions of distance may influence their engagement in AST. This is illustrated by research conducted by Kingsly et al. (2020) in Chennai, India, which found that students who viewed their school as “too far” were 75% less likely to engage in AST (Kingsly et al., 2020). Conversely, research from Tetali et al. in Hyderabad revealed that children living 2–3 km from school were more than three times as likely to cycle compared to those residing within 1 km, suggesting a significant shift in preferred AST modes based on distance (Tetali et al., 2016). Given that our study grouped walking and cycling together under AST without differentiating between these modes, future research should explore how parental restrictions may uniquely influence engagement in each travel mode, considering the distinct safety concerns and feasibility associated with walking versus cycling. Examining these differences could reveal whether parental restrictions are mode-specific, ultimately informing strategies to address specific barriers to walking and cycling and to enhance CIM.

4.7. Disagreement with Footpath Presence Associated with Higher AST

Footpaths on neighbourhood streets are a fundamental component of active transportation infrastructure and have been frequently reported as supportive factors for AST across various settings and populations (Bhawra et al., 2023a; Chen et al., 2018, p. 2022; Promoting Walking and Cycling, 2025; Schicketanz et al., 2024). Evidence further shows that well-maintained streets and sidewalks are associated with higher rates of AST, while poor sidewalk conditions are commonly cited as barriers by children, youth, and their caregivers (Das & Banerjee, 2023; Kerr & Sallis, 2006; Larouche et al., 2015; Torres et al., 2022). Contrary to previous findings, in our study, we found that disagreement with the statement “There are footpaths on most of the streets in my neighbourhood” was associated with higher odds of AST overall, among children and youth living in rural regions, and among females. These associations remained significant following adjustment for children’s and youths’ perceptions of air pollution. These contrasting findings may reflect unique contextual factors that influence transportation decisions for school commutes, such as transportation availability (Cropper & Bhattacharya, 2007; Tyagi & Raheja, 2021b, 2021a), affordability (Ermagun & Samimi, 2018; Larouche et al., 2018), and parental decision-making (Mah et al., 2017; Nicholoff et al., 2024; Tyagi & Raheja, 2021a). Several studies suggest that, alongside personal or parental preference, engagement in AST may also reflect limited alternative transportation options, including lack of private vehicle ownership and inadequate access to school or public transportation (Tetali et al., 2016; Tiwari et al., 2016). In settings where alternative transportation options are available, low household income can contribute to restricted access to both private vehicles and alternative modes of transportation due to financial barriers. For example, in Bengaluru, India, Ghosh et al. (2023) found that metro rail commuters reported more than twice the average household income of bus users while incurring nearly three times the average monthly travel cost, highlighting affordability as an important determinant of transport mode choice for low- and middle-income individuals (Ghosh et al., 2023). Such constraints may shape the extent of the environmental benefits that can be realized from metro ridership and, more broadly, from the choice between costly and more affordable modes of transport with differing environmental implications (Ghosh et al., 2023; N. Sharma et al., 2014; Soni & Chandel, 2018). In addition, access to alternative transportation may not lead to use when parental safety concerns, expressed through restrictions on independent commute by children and youth, serve as barriers. For instance, a study by Tyagi and Raheja reported that a majority of parents in an urban Delhi neighbourhood perceived the Delhi Metro as unsafe for CIM, illustrating how perceived safety risks may deter the use of available transport modes, despite the presence of developed infrastructure (Tyagi & Raheja, 2021b). A global review of 49 countries further reported that active transport rates were higher in low- and middle-income countries than in high-income countries, suggesting that economic and structural constraints may result in increased reliance on AST, despite infrastructural limitations (González et al., 2020). It is possible that, in our study settings, factors such as accessibility, affordability, and trust in the safety of the surrounding environment played a more influential role than the quality of active transportation infrastructure in shaping school commuting decisions. These findings highlight the importance of interpreting perceived infrastructure quality within the broader context of local structural conditions. Future research should aim to measure and model how factors such as socioeconomic conditions and transportation access intersect to shape perceptions of active transportation infrastructure and their influence on children’s AST across diverse socioecological settings.

4.8. Implications for Policy and Practice: Promoting AST in India

Recent evidence from India and other low- and middle-income countries highlights the importance of prioritizing a targeted set of responsive policies that address current infrastructure, safety, and climate-related challenges for physical activity. These policies can support children’s and youths’ physical activity in part by improving the feasibility of AST. The 2022 India Report Card on Physical Activity for Children and Adolescents graded the community and built environment indicator, a measure of infrastructure availability, policy accountability, and municipal support for physical activity, as a “D,” reflecting limited progress in creating walkable and bike-friendly environments around schools (Bhawra et al., 2023a). Although approximately 60% of Indian children currently walk or cycle to school based on available evidence, this trend may reflect limited access to motorized transport and reliance on more affordable travel options, rather than the presence of a built environment designed to support safe and independent mobility (Bhawra et al., 2023a; Tetali et al., 2016). In this context, initiatives such as Bangalore’s Cycle Day, organized by the Coalition for Open Streets in collaboration with local governments, civil society, and residents, offer a promising example of how community-led, car-free events can raise awareness, promote safer streets, and encourage public investment in active travel infrastructure. Complementary measures, such as constructing continuous footpaths and protected bike lanes, adding clearly marked crosswalks, and enforcing reduced-speed school zones (e.g., 30 km/h limits), can further enhance safety and encourage AST engagement (Promoting Walking and Cycling, 2025). Nevertheless, while various reports describe active transportation initiatives across the country, there is limited evidence of implementation or documented outcomes, and no current comprehensive national strategy exists to promote daily movement through active travel (Bhawra et al., 2023a). Shifting national priorities toward intersectoral strategies that actively involve local communities in decision-making will be critical for enhancing AST. Key actions include integrating walking and cycling infrastructure into school planning, adopting urban-design approaches that shorten travel distances, expanding community-based programs beyond major cities, and systematically tracking implementation outcomes to sustain everyday physical activity among children and youth. (Bhawra et al., 2023a; Chanpariyavatevong et al., 2024; Promoting Walking and Cycling, 2025; Tetali et al., 2016).

5. Strengths and Limitations

This exploratory study examined parental restrictions on outdoor activities due to air pollution, highlighting the critical role of parents in shaping their children’s physical activity opportunities. Using self-reports from children and youth, this study is the first to quantitatively explore parental influence on AST engagement, and this specific relationship in the Indian context, particularly across both urban and rural regions (Tetali et al., 2016). Previous research on parental and guardian decision-making regarding children’s and youths’ transport modes has largely leveraged qualitative approaches, such as interviews and focus groups with parents (Tyagi & Raheja, 2021a, 2021b). Accordingly, at this early stage, measurement-related limitations should be carefully considered and addressed in future study designs.

While a previous study conducted among 6th-grade school children in Norway found self-reported AST to have high test–retest reliability (Bere & Bjørkelund, 2009), the present study involved the development and administration of a novel survey with original questions and content areas. As such, the reliability and validity of this instrument have not yet been established. Additionally, while participants under 13 years of age received parental and/or guardian guidance, the extent and nature of that involvement during survey completion remain unknown, potentially introducing variability in reporting and response accuracy. Such variability may be particularly important to consider given that the questionnaire included several Likert scale items, which younger children may have found challenging to comprehend, potentially influencing the accuracy of their responses (Mellor & Moore, 2013). It also included mathematical concepts, such as kilometres as a unit of distance and comparison symbols like “>”, which are typically introduced at ages 8–9 (Grades 3–4) in the National Council of Educational Research and Training curriculum in India, and may vary across other curricula, suggesting that younger children may not have had sufficient exposure to accurately interpret such content (Gupta, 2020).

Moreover, the dichotomization of variables, such as parental restrictions and children’s and youths’ air pollution perceptions, may have further limited our ability to detect subtle nuances in participants’ responses and behaviours. To enhance measurement quality, future studies should consider employing multi-item validated scales.

While our models included children’s and youths’ perceptions of air pollution, we did not assess how these perceptions interact with parental restrictions to influence AST engagement. Additionally, the reliance on self-reported data from children and youth and the use of a single question to measure parental restrictions limited our ability to assess the contextual factors influencing parental decisions to restrict outdoor activity. As a result, we could not capture nuances such as parents’ prior negative experiences with air pollution or exposure to media coverage of air pollution, which may shape their perceptions. Furthermore, we did not examine whether children or parents had underlying medical conditions that may influence their family’s active living behaviours and efforts to minimize exposure to air pollution, potentially leading to stricter parental restrictions or more frequent avoidance of AST among all outdoor activity. The absence of objective air quality measurements and weather conditions during data collection limits our understanding of how parental and child perceptions align with actual air pollution levels and how they may be influenced by climate variability. Evidence from India indicates that weather variations influence air pollution levels and outdoor physical activity patterns in children and youth (Katapally et al., 2015, 2015; Katapally & Muhajarine, 2015; Muhajarine et al., 2015); therefore, without these data we cannot fully assess the degree to which real-time environmental conditions shape parental decision-making and children’s engagement in AST. In addition, the cross-sectional design of this study, which did not allow for tracking changes in parental restrictions or children’s and youths’ perceptions over time, further limits our ability to draw conclusions about the relationship between dynamic environmental conditions, changing human behaviours, and decision-making about outdoor activity. We also acknowledge that non-response and selection bias may have affected the representativeness of the final study sample.

Future longitudinal studies could employ mHealth strategies or digital citizen science approaches—using smartphones, wearable sensors, or other tools—to capture real-time data on air quality, weather variations, parental perceptions, and children’s school commutes (Ibrahim et al., 2023; Katapally et al., 2020; Katapally & Chu, 2020). These approaches could also incorporate additional psychosocial and practical determinants of AST engagement, such as social support, time constraints, and access to equipment like bicycles or helmets (Aranda-Balboa et al., 2020; Ikeda et al., 2020; Savolainen et al., 2024). Using these methods would enable a more comprehensive understanding of how daily variation in personal health metrics, physical activity, routines, and one’s physical and built environment influence decisions about AST.

6. Conclusions

By integrating both parental restrictions and children’s perceptions of air pollution, this is the first study to examine the relationship between parental restrictions on outdoor activities and AST participation among children and youth in India, while considering variations across age, gender, and location. The findings indicate that parental restrictions due to air pollution concerns, along with commuting distances exceeding two kilometres, are associated with a lower likelihood of AST participation. Given that AST serves as a key source of regular physical activity for children in India, these findings highlight the need for strategies that promote safe and healthy environments conducive to active mobility. Parental restrictions on outdoor activity may also contribute to broader limitations on independent mobility, which could, in turn, decrease overall physical activity levels. Urban planners and policymakers should consider interventions to enhance walkability, such as improving pedestrian infrastructure, expanding crosswalks, and developing dedicated cycling lanes, while also implementing regulations to mitigate vehicular and industrial emissions near schools and residential areas. These measures may alleviate parental concerns, increase the feasibility of AST, and contribute to both public health and environmental sustainability. Ultimately, these findings point toward the need for multisectoral solutions that recognize the interconnectedness of environmental health, built infrastructure—which varies across urban and rural regions—and parental decision-making. To effectively address parents’ unique safety concerns, it is crucial to involve them as key stakeholders in the design, development, and implementation of future AST and physical activity interventions. Adopting such a community-based approach to urban planning will enhance efforts to promote active living practices among children and youth.