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O ver the past decade, as obesityhas continued to rise amongboth youth and adults, interest

has grown in developing policies topromote community environments thatsupport healthy lifestyles.1 A broadrange of local, regional, state, and fed-eral policies under the rubrics of activeliving, smart growth, and sustainabledevelopment share the underlying as-sumption that they can help people makehealthier choices. From a transportation-planning perspective, the benefits ofpedestrian and bicycle plans resulting

from the building of infrastructure tosupport pedestrian and bicycle travelinclude improved health (for example,through increased levels of physicalactivity and reduced obesity), a betterenvironment (for example, throughlower carbon emissions), and a strongereconomy (for example, through lowerfuel bills). However, until more recently,the health benefits have not beenspecifically explored.

Physical inactivity, obesity, diabetes,and related conditions lead to an enor-mous cost. North Carolinians spendmore than $24 billion annually onhealth care costs related to them.2 Thedisciplines of planning and health havebegun to work together on finding waysto address physical inactivity and obe-sity. For example, the physical environ-ment may lack sidewalks or trails al-lowing people to walk or bicycle totheir destinations. Planning tools, in-cluding a pedestrian or bicycle plan,help ameliorate such a situation.

Issues like accessibility are importantto many North Carolina adults. In2007, 60 percent of them reported thatthey would increase their physical ac-tivity if their community had more accessible sidewalks or trails for walk-ing or bicycling. Notably, the preva-lence of this view varied by region, with

eastern North Carolina having thehighest (63 percent), followed by thePiedmont (59 percent) and westernNorth Carolina (53 percent).3

Despite the growing popularity ofresearch and practice related to the builtenvironment and health, little is knownabout local policies and planning pro-cesses to support active living. Pedes-trian and bicycle plans are one way tosupport active living. This article pro-vides an overview of the developmentand the prevalence of pedestrian andbicycle plans in North Carolina.

Pedestrian and Bicycle Planning

A pedestrian or bicycle plan is a publicdocument usually developed throughpublic participation, visioning, and an analysis of current conditions. The planning process brings together interested parties, such as staff of lo-cal and regional organizations, repre-sentatives of the state department oftransportation, citizens, consultants,and local advocates. The resulting plantypically lays out a community’s visionfor future pedestrian and bicyclingactivity, identifies the actions requiredto realize that vision, ties actions tofunding sources, and describes imple-mentation and use.

Evenson is a research associate professorof epidemiology at UNC at Chapel Hilland the principal investigator of the NorthCarolina Physical Activity Policy ResearchCenter. Satinsky is a graduate student inthe Departments of City and RegionalPlanning and Health Behavior and HealthEducation at UNC at Chapel Hill. Ayturrecently completed a postdoctoral fellow-ship at UNC at Chapel Hill and now is apolicy research specialist at the Seattle andKing County Public Health Department inWashington state. Rodríguez is thedirector of the Carolina TransportationProgram and associate professor of cityand regional planning at UNC at ChapelHill. Contact them at kelly_evenson@unc.edu, satinsky@email.unc.edu,s_aytur@yahoo.com, and danrod@unc.edu.

P O P U L A R G O V E R N M E N T

Planning for Pedestrians and Bicyclists in North Carolina Kelly R. Evenson, Sara B. Satinsky, Semra A. Aytur, and Daniel A. Rodríguez

f a l l 2 0 0 9 15

Pedestrian and bicycle plans are de-fined geographically, either for a muni-cipality or for a broader area, such as acounty, a region, or an entire state. Oftenpedestrian and bicycle plans are deve-loped as separate documents, but some-times a plan is targeted at both pedestrianand bicycle needs. In other cases, pedes-trian and bicycle plans are embedded in

broader plans, such as those for compre-hensive land use, transportation, green-ways, open space, or parks and recreation.

Pedestrian and bicycle plans promotea community’s vision and guide futurepriorities and investments. For example,some plans include visions of using anarea’s pedestrian friendliness to attractheritage tourism, whereas other plans

view pedestrian activity as a way ofsimultaneously achieving a more bal-anced transportation system and con-tributing to social and environmentalsustainability. Other visions and goalsof a plan might be as follows:

• Improving connectivity of sidewalks,trails, or bike lanes for pedestriansand bicyclists

• Improving safety and preventinginjury for pedestrians and bicyclists

• Improving or maintaining existingpedestrian or bicycle facilities (forexample, sidewalks and bike racks)

• Reducing traffic congestion

• Enhancing quality of life

• Improving public health

• Encouraging general recreation orphysical activity

• Promoting economic developmentthrough tourism

Each plan is unique and tailored to the community, creating variationamong plans in focus, scope, andstrength. In addition to expressing acommunity’s vision and goals, a planshould include an assessment of currentconditions for pedestrians and bicyclists(including an assessment of past injuriesand crashes), and it should documentpublic participation contributing to itsdevelopment. A plan also should in-clude an assessment of the sociodemo-graphic characteristics of the area andprojections for the future (for example,an increasing population of elderlyresidents) that may highlight the needs of special populations with respect towalking and bicycling. Further, a planshould contain a review of existingpolicies, ordinances, and programs,including how they might affect pedes-trians and bicyclists. Detailed maps ofcurrent conditions and proposed changesto infrastructure should be part of aplan as well, including maps of side-walks, greenways, rails-to-trails, bikelanes, paved shoulders, and crosswalks(for an example, see Figure 1).

A plan should include recommenda-tions related to its goals, such as changesin policies, investments in facilities, im-proved maintenance, or establishmentof programs, with a ranking of theirrelative priority. (For an example of a

Figure 1. A Simplified Comprehensive-System Map for Troutman, North Carolina, Showing Recommended Projects Based on thePedestrian Planning Process

Source: Map reprinted, with permission, from the Troutman (North Carolina) Pedestrian Plan(February 2008). Created and simplified by Blair Israel, Centralina Council of Governments,Charlotte, North Carolina. To see the original, go to www.unc.edu/~kevenson/_Figure1_TroutmanNC.pdf.The green dashes represent proposed trails; the blue dashes, proposed sidewalks; the red lines,existing sidewalks; the pedestrian symbols, crosswalks; and the “P” symbols, Park & Ridelocations.

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picture of current conditions, see Figure2a. For changes that could be made toincorporate more pedestrian- andbicycle-friendly elements, see Figure 2b.)

A plan also should include a timelinefor implementation, cost estimates, areview of potential funding sources, anddesign guidelines for the construction ofnew facilities. Finally, it is important for

a plan to include an evaluation compo-nent, to assess whether goals are reachedover a specific time period.

A pedestrian or bicycle plan covers a cross-section of interests, as illustratedby these examples of visions, goals, andplan components. It reflects the diversityof professionals and community memberswho develop it, including people from

local government, city planning, transpor-tation planning, parks and recreation, en-gineering/public works, and public health.

Planning for Pedestrians andBicyclists in North Carolina

Given the potential importance of ped-estrian and bicycle plans as components

Figures 2a & 2b. Existing Conditions and Possible Improvements, Pittsboro, North Carolina

Source: Photos reprinted, with permission, from the Pittsboro Pedestrian Transportation Plan (2009), authored by Jason Reyes, AICP, and MattHayes, AICP, of Greenways, Inc. Photo rendering by Jason Reyes. Available at www.greenways.com/pittsboro_download.html.

Above, existing conditions in 2008 looking east on East Street in Pittsboro; below, several possible improvements,including street trees, street furniture, landscaped medians, pedestrian-scale lighting, bicycle lanes, wider sidewalks,sidewalks on both sides of the road, closing of curb cuts (reduction of parking-lot access points), and crosswalks.

f a l l 2 0 0 9 17

of a public policy process to improvesustainability and influence residents’health, the North Carolina PhysicalActivity Policy Research Center soughtto examine more closely the character-istics of plans in the state.4 A first step

was to identify all pedestrian and bicycleplans in North Carolina completedthrough fall 2008.5 Although some mu-nicipalities have plans under develop-ment, we did not include them in ourstudy if they were not completed beforethis date. To collect all plans, we con-ducted Web searches, accessed the plan

library of the North Carolina Departmentof Transportation (NCDOT), Divisionof Bicycle and Pedestrian Transportation,and called to follow up when necessary.We also sent our plan list to a listservof North Carolina planners to identifyany missing plans. In instances in whicha community had updated its plan, wecounted and collected only the mostrecent plan. Even with this thoroughsearch strategy, we may have inadver-tently missed some plans, for not alldocuments were easily accessible.

In North Carolina, there are 100counties, 17 metropolitan planning or-ganizations (MPOs), 20 rural planningorganizations (RPOs), and 544 munici-palities.6 We identified 72 current plansin the state, 29 of them pedestrian, 30 of them bicycle, and 13 of themcombined pedestrian and bicycle (seeTables 1–3). One plan was at the statelevel, 11 were at the regional level, 4 wereat the county level, and 56 were at themunicipality level. Of the 11 regionalplans, 8 were developed for MPOs, 2were developed for RPOs, and 1 wasdeveloped by an interjurisdictionalorganization in the Piedmont called theCenter of the Region Enterprise.7

For the municipalities, bicycle andpedestrian plans existed in all three

Table 1. Most Recent PedestrianPlans in North Carolinathrough 2008

Locality Year Plan Level

Albemarle 2007 Municipality

Asheville 2004 Municipality

Badin 2008 Municipality

Black Mountain 2008 Municipality

Boiling Springs 2006 Municipality

Brevard 2006 Municipality

Bryson City 2007 Municipality

Burnsville 2006 Municipality

Cary 2007 Municipality

Conover 2008 Municipality

Durham 2006 Municipality

Graham 2006 Municipality

Hendersonville 2007 Municipality

Hertford 2007 Municipality

Holly Springs 2007 Municipality

Kannapolis 2007 Municipality

Kenansville 2007 Municipality

Mars Hill 2007 Municipality

Mooresville 2006 Municipality

Nashville 2008 Municipality

Norwood 2007 Municipality

Shelby 2007 Municipality

Sparta 2006 Municipality

Stallings 2008 Municipality

Troutman 2008 Municipality

Wake Forest 2006 Municipality

Washington 2006 Municipality

Wilson 2006 Municipality

Winston-SalemUrban Area 2007 MPO

Note: In Tables 1–3, the year of the plan maynot match the adoption date. MPO = metro-politan planning organization. RPO = ruralplanning organization. As the authors identifynew plans through 2008, they will update thetables at the following website: www.unc.edu/~kevenson/_NCPedBikePlans.pdf. Only stand-alone plans are included. Plans with pedes-trian or bicycle elements (e.g., comprehen-sive, transportation, park, livable-community,or main-street plans) are not included.

Table 2. Most Recent Bicycle Plansin North Carolina through2008

Locality Year Plan Level

Asheville 2008 Municipality

Carolina Beach 1985 Municipality

Carrboro 1980 Municipality

Charlotte 1981 Municipality

Clayton 2007 Municipality

Durham 2006 Municipality

Durham–Chapel Hill–Carrboro MPO 1993 MPO

Elizabeth City 1985 Municipality

Fayetteville 1980 Municipality

Forsyth County 1988 County

Goldsboro 1975 Municipality

Greenville 1974 Municipality

Greenville Urban Area 2002 MPO

Lake Norman 2006 RPO

Matthews 2006 Municipality

MecklenburgCounty 1977 County

Mooresville 2008 Municipality

Morehead City 2007 Municipality

New Bern 2006 Municipality

North Topsail Beach 2006 Municipality

Oak Island 2006 Municipality

Raleigh 1991 Municipality

Rocky Mount 2007 Municipality

Tarboro 2006 Municipality

Washington 2008 Municipality

Wilmington Area 1981 MPO

Wilson 2008 Municipality

Winston-Salem 1974 Municipality

Winston-SalemUrban Area 2005 MPO

WrightsvilleBeach 2005 Municipality

Table 3. Most Recent CombinedPedestrian/Bicycle Plans in North Carolina through2008

Locality Year Plan Level

Alamance County 1994 County

Boone 1995 Municipality

Caldwell County 2004 County

CAMPO (CapitalArea MPO) 2003 MPO

Chapel Hill 2005 Municipality

CORE (Center of the Region Enterprise) 2005 Region

Fayetteville MPO 2004 MPO

Greensboro 2006 MPO

Hickory 2005 Municipality

Kernersville 2007 Municipality

Kings Mountain 2002 Municipality

Mid-Carolina RPO 2005 RPO

North Carolina 1996 State

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Table 5. Summary of the North Carolina Bicycle and Pedestrian Planning Grant Initiative, 2004–8

Pedestrian Planning Grants Bicycle Planning Grants

Range Municipality Range Municipality No. of Grants in Award Population No. of Grants in Award Population

Year Awarded Amount Range Awarded Amount Range

2004 13 $9,040–$37,500 1,641–570,353 5 $16,800–$36,000 833–55,998

2005 13 $12,000–$24,500 1,181–107,693 5 $20,000–$75,000 7,821–614,330

2006 6 $16,000–$31,500 1,971–23,688 6 $22,400–$90,000 4,703–344,000

2007 13 $16,000–$39,000 2,802–91,207 3 $28,000–$45,500 8,100–26,084

2008 14 $20,000–$31,500 999–58,000 2 $28,000–$31,850 4,261–16,042

Source: North Carolina Department of Transportation, Division of Bicycle and Pedestrian Transportation, North Carolina Department ofTransportation Bicycle and Pedestrian Planning Grant Initiative (2008), www.itre.ncsu.edu/PTG/BikePed/NCDOT/index.html.

Table 4. Census Characteristics of All North Carolina Municipalities, Overall and among Those with and without a Pedestrian, Bicycle, or Combined Pedestrian/Bicycle Plan

Characteristic All Municipalities Municipalities with Plan Municipalities without PlanN = 544 N = 51 N = 493

Population % n % n % n

1–5,000 80.1 436 29.4 15 85.4 421

5,001–30,000 16.0 87 43.1 22 13.2 65

30,001+ 3.9 21 27.5 14 1.4 7

Speed of Population Growth*

Decline (–100%–0%) 24.8 134 13.7 7 26.0 128

Slow growth (>0%–15%) 48.2 261 49.0 25 47.9 236

Moderate to fast growth(>15%) 27.0 146 37.3 19 25.8 127

Race

0%–10% nonwhite 28.5 155 17.6 9 29.6 146

>10%–20% nonwhite 17.3 94 19.6 10 17.0 84

>20% nonwhite 54.2 295 62.7 32 53.3 263

Average Median Income

<$30,000 38.8 211 25.5 13 40.2 198

$30,000 61.2 333 74.5 38 59.8 295

Source: U.S. Bureau of the Census, Census 2000 Summary File 3 for North Carolina Places, Table P53, Median Household Income in 1999 (dollars),http://factfinder.census.gov/servlet/BasicFactsServlet. Median income is based on 1999 reports. Percentages may not add to 100 because ofrounding.*This sample size is 541 because 2006 estimates were not available for three municipalities. Population growth is defined from 2000 to 2006.

regions of the state.8 Of the 544 muni-cipalities in North Carolina, 28 havepedestrian plans, including 5 in theeastern region, 15 in the Piedmont, and8 in the western region.9 In addition, 23 have bicycle plans, including 15 in theeastern region, 7 in the Piedmont, and 1 in the western region. Only 9 munici-palities have both a pedestrian and abicycle plan, 5 of them with combinedplans and 4 with separate plans. ThePiedmont has the highest number of

pedestrian plans, the eastern region thehighest number of bicycle plans.

More municipalities with a popula-tion greater than 5,000 had plans, thandid municipalities with a population of5,000 or fewer (see Table 4). Pedestrianand bicycle plans also were morecommon among municipalities withrecent population growth and in areaswith more racial diversity (more than20 percent nonwhite) and a highermedian income.10

We reexamined our findings amongmunicipalities with at least a populationsize of 3,000, to explore whether thecutoff point we chose for populationsize influenced our results. We obtainedsimilar results on three dimensions:pedestrian and bicycle plans were morecommon among municipalities that hada larger population, had experiencedrecent population growth, and hadmore racial diversity. The differences byincome were diminished.

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Across the state, most of the 72 planswere first generation, but at least 10 ofthem had been updated from a previousplan. The plans were developed eitherby in-house staff or by consultants orregional staff. Of the 72 plans, almosthalf (44 percent) were developed usingconsultants. Of the current plans, 18bicycle and combined pedestrian/bicycleplans existed in North Carolina before2004, with the earliest dating back to1974. We found only one pedestrianplan that existed before 2004. Thistrend is, in part, due to the developmentof a grant initiative by NCDOT.

The Grant Initiative

For at least two reasons, local governmentsare well positioned to enhance physicalactivity and promote alternative transpor-tation modes by developing pedestrianand bicycle plans. First, most walkingor bicycling for transport or recreationtends to occur locally, near or originatingfrom where people live.11 Second, localgovernments oversee land-use planningand development, thereby influencingwhether the environment supports ordiscourages walking or bicycling.

To encourage the development ofcomprehensive local pedestrian andbicycle plans, in 2003, NCDOT’s Divi-sion of Bicycle and Pedestrian Transpor-tation and its Transportation PlanningBranch created a matching grant pro-gram.12 Over the past five grant cycles(2004–8), the program has awardedeighty planning grants totaling morethan $1.9 million (see Table 5).13 Thecommunities that have received fundingrange greatly in size and industry, fromtowns more reliant on tourism, such asNorth Topsail Beach and Sparta, to thecapital city, Raleigh.

The NCDOT grant initiative spurreddevelopment of pedestrian and bicycleplans. Only municipalities could applyfor grants; nonmunicipal entities (forexample, counties, MPOs, RPOs, anduniversities) were not eligible. However,municipalities that had developed pe-destrian or bicycle plans within the lastfive years were not eligible to apply. Themunicipalities that received a grant wererequired to provide a monetary matchbased on a sliding scale (determined bypopulation size), and to assign an em-

Why the Concern? A Public Health Perspective In North Carolina, concerns about obesity and physical inactivity of both youthand adults continue to escalate as surveillance data are released on thesebehaviors each year. A 2007 statewide survey of adults reporting on theirchildren revealed that 17 percent of children in grade school (kindergartenthrough fifth grade) exceeded the 95th percentile on weight for height. Theprevalence was higher among middle school students (18 percent) and loweramong high school students (14 percent).1

The high prevalence of obesity among youth can be partially attributed tolack of physical activity and high inactivity. A self-reported schoolwide surveyin 2007 revealed that the proportions of middle and high school students whohad been physically active for at least one hour on five or more days of thepreceding week were 55 percent and 44 percent respectively. At the sametime, 44 percent of middle school and 35 percent of high school studentsreported watching three or more hours of television per day on an averageschool day. In addition, 25 percent of middle school and 21 percent of highschool students reported playing video or computer games or using the com-puter (not for school work) three or more hours on an average school day.2

A high prevalence of obesity and lack of physical activity also occurs amongadults of North Carolina. The prevalence of obesity reached a high of 29 per-cent in 2007, an absolute increase of 16 percent since 1991 (when theprevalence was 13 percent).3 Obesity differs regionally, with the highestprevalence in eastern North Carolina (31 percent) and slightly lower preva-lences in the Piedmont (28 percent) and western North Carolina (26 percent).Concurrently in 2007, 24 percent of adults reported no participation in anyphysical activities or exercises during the past month, with eastern NorthCarolina reporting the highest prevalence (27 percent), followed by the Pied-mont (24 percent) and western North Carolina (23 percent).4

Notes1. North Carolina State Center for Health Statistics. North Carolina Child Health Assessment

and Monitoring Program, www.schs.state.nc.us/SCHS/champ/index.html. 2. North Carolina Department of Public Instruction and North Carolina Department of

Health and Human Services, North Carolina Youth Risk Behavior Survey (YRBS), www.nchealthyschools.org/data/yrbs/.

3. Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System,Prevalence Data, 2007, www.cdc.gov/brfss; North Carolina State Center for HealthStatistics, Behavioral Risk Factor Surveillance System (BRFSS), Calendar Year 2007Results, www.schs.state.nc.us/SCHS/brfss/2007/index.html.

4. Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System,Prevalence Data, 2007; North Carolina State Center for Health Statistics, Behavioral RiskFactor Surveillance System (BRFSS), Calendar Year 2007 Results.

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ployee to coordinate the process. Moredetails on the grant process and reviewcan be found elsewhere.14

Of the 72 pedestrian and bicycle plansidentified in North Carolina, 41 weremunicipalities that were eligible to re-ceive an NCDOT grant. Of those mu-nicipalities, 90 percent received fundingfrom the initiative.

The grant initiative made the cre-ation of plans more feasible in manycommunities and appears to be reachingmore diverse communities with respectto population, race, and median income.We explored associations among the 41 municipalities eligible for fundingthat had either a pedestrian or a bicycleplan. Approximately one-third (13) ofthe NCDOT–funded plans were in communities with a population of lessthan 5,000, compared with only 2locally funded plans in communitieswith a similar population size. Popula-tion growth was not associated withfunding source. Municipalities withmore racial diversity, defined as morethan 20 percent nonwhite, were morelikely to have a pedestrian or bicycleplan if funded by the NCDOT pro-gram. Similarly, communities with amedian income of less than $30,000were more likely to have a pedestrian or bicycle plan if funded by theNCDOT program.15

In summary, theNorth Carolina grantprogram has had asignificant impact onthe number of pedes-trian and bicycle plansin the state. A surge inthe development ofpedestrian and bicycleplans started a fewyears ago, concurrent with the initiationof the grant program. Although theincrease is promising, manycommunities currently do not haveeither a pedestrian or a bicycle plan.Despite the public support of pedestrianand bicycle facilities, of the 544municipalities in North Carolina, wefound that only 28 had a pedestrianplan, 23 a bicycle plan, and 5 a com-bined pedestrian and bicycle plan. Thus a positive opportunity still existsfor many municipalities. Furthermore,additional financial support for plans

to be developed in smaller munici-palities is important, because they areless likely to have such plans and mayneed to improve pedestrian and bicycleactivity.

Further Questions about the North Carolina Plans

Having documented thenumber of plans in thestate, we see our next stepas examining the qualitiesof the plans that makethem useful to thecommunities. Mostplanners can distinguishhigh-quality plans from

low-quality ones, but the characteristicsshared by plans are rarely enunciated.These attributes are important toidentify and understand, for high-quality plans are better positioned toinfluence outcomes, and clarifying theirfeatures could greatly benefit the devel-opment of future plans and updates toexisting plans.

The North Carolina Physical ActivityPolicy Research Center will engage indoing just that, by exploring the contentof the plans across North Carolina. Wewill assess the content of selected plans

by abstracting or collecting similarinformation in a systematic and reliableway. The aspects that we will abstractinclude plan components (for example,summary, glossary, and maps), publicparticipation, plan goals and objectives,analysis of current conditions and trends,relationship to other existing plans,policy recommendations, and methodof implementation.

Further research also can help usbetter understand the factors thatmotivate planners, policy makers, and residents to develop pedestrian and bicycle plans. To what extent arehealth issues identified as motivatingfactors, among a constellation of othervalues? Which stakeholders areinvolved in the planning process, whichinterests drive various decisions, andhow are the needs of diverse groupsrepresented? What factors or conditionsmotivate some groups to abandonplanning and pursue their goals viaalternative pathways—for example,informal decisions, agreements withprivate developers, or grassrootscoalitions to promote activities such ascommunity-based walking groups andincentives for employees who walk orbike to work? Finally, the extent towhich pedestrian and bicycle plans areembedded in other plans, like a

The state’s grant initiativemade the creation ofpedestrian and bicycle plansmore feasible for manylocalities and is reachingmore diverse communities.

f a l l 2 0 0 9 21

comprehensive plan, could be docu-mented, and integration of the plansmight be further explored. Also, itwould be helpful to understand howpedestrian and bicycle issues are ad-dressed in localities without pedestrianor bicycle plans.

Conclusion

In North Carolina, planning for bicyclingdates back to the 1970s, with pedestrianplanning not following until 2004 (withone exception). We identified 72 planscurrently available in the state, 82 percentof which dealt with pedestrian and bi-cycle planning separately, the other 18 per-cent jointly. The NCDOT grant programhas been a catalyst in the development ofpedestrian and bicycle plans statewide,addressing communities’ interests inpromoting walking and bicycling.

Establishing a pedestrian and bicycleplan is one approach that local govern-ments can use to help set goals andbenchmarks for a more pedestrian- andbicycle-friendly community. Despite theprogress made, a majority of communitiesin North Carolina have neither a pedes-trian nor a bicycle plan and may not havean element of either type of plan in otherplans. The lack of a plan represents afavorable opportunity for many commu-nities. Communities with plans may have,over time, more infrastructure for pe-destrian and bicycle activity in the com-munity, which may contribute to morephysical activity and less obesity. This isjust one of many benefits that mightaccrue; other benefits might include ad-ditional health improvements, as well asenvironmental and economic improve-ments. It will be important to documentand understand the outcomes of thispedestrian and bicycle planning processin North Carolina over the years ahead,as more plans are funded locally or takeadvantage of available funding from theNCDOT grant initiative.

Notes

The work reported in this article wassupported by the North Carolina PhysicalActivity Policy Research Center, funded bythe Centers for Disease Control andPrevention (CDC) cooperative agreement

#U48-DP000059 and an educational grantfrom the Southern Transportation Center atthe University of Tennessee. The UNCCenter for Health Promotion and DiseasePrevention is a member of the PreventionResearch Centers Program of CDC. Thecontent of the article is solely the responsi-bility of the authors and does not necessarilyrepresent the official views of the CDC. We thank Ginny Lee, David Salvesen, andNCDOT, Division of Bicycle and PedestrianTransportation, especially Helen Chaney and Mary Meletiou.

1. Cynthia L. Ogden et al., “Prevalenceof Overweight and Obesity in the United States,1999–2004,” JAMA 295: 1549–55 (2006).

2. North Carolina Department of Healthand Human Services, Physical Activity andNutrition Branch, Eat Smart, Move More NC,The Obesity Epidemic in North Carolina,app. I: Fast Facts, www.eatsmartmovemorenc.com/ObesityInNC/ObesityInNC.html.

3. North Carolina State Center forHealth Statistics, Behavioral Risk FactorSurveillance System (BRFSS), Calendar Year2007 Results, www.schs.state.nc.us/SCHS/brfss/2007/index.html.

4. The Physical Activity Policy ResearchNetwork, established in 2004, conductstransdisciplinary policy research by exam-ining physical activity policies, identifyingtheir determinants, describing the process ofimplementing them, and researching theoutcomes. For more information, visit thenetwork’s website, http://prc.slu.edu/paprn.htm. North Carolina is home to oneof the participating centers. For moreinformation about the North Carolinacenter, visit its website, www.hpdp.unc.edu/projects/ncpaprc.

5. Most of the plans that we identifiedprobably had been adopted, but the plan typically did not include documentation of this.

6. Metropolitan planning organizations(MPOs) are transportation planning organi-zations for urbanized areas with populationsgreater than 50,000 that work in coopera-tion with state and federal governments tohave continuing, cooperative, and compre-hensive transportation planning processes.At present, North Carolina includes seven-teen urban areas with corresponding MPOs:Asheville, Burlington, Cabarrus-Rowan,Charlotte, Durham–Chapel Hill–Carrboro,Fayetteville, Gastonia, Goldsboro, Greens-boro, Greenville, Hickory-Newton-Conover,High Point, Jacksonville, Raleigh, RockyMount, Wilmington, and Winston-Salem.North Carolina Department of Transpor-tation, Transportation Planning Branch,Metropolitan Planning Organizations,www.ncdot.org/doh/preconstruct/tpb/mpo/mpo.html. Rural planning organizations(RPOs) are transportation planning organi-zations that provide a forum for public

participation in rural transportation issuesand policies and work in coordination withthe state government and the MPO. Initiatedin 2000, RPOs in the state now numbertwenty: Albemarle, Cape Fear, Down East,Eastern Carolina, High Country, Isothermal,Kerr-Tar, Lake Norman, Land of Sky,Lumber River, Mid-Carolina, Mid-East,Northwest Piedmont, Peanut Belt, PiedmontTriad, Rocky River, Southwestern, TriangleArea, Unifour, and Upper Coastal Plain.North Carolina Department of Transporta-tion, Transportation Planning Branch, RuralPlanning Organizations, www.ncdot.org/doh/preconstruct/tpb/mpo/rpo.html.

7. The Center of the Region Enterprise(CORE) includes six local governments(Durham County, Durham City, WakeCounty, Raleigh, Cary, and Morrisville),several regional organizations, and multipleprivate-sector parties. For more information,visit CORE’s website, www.tjcog.dst.nc.us/regplan/core.shtml.

8. Regions in North Carolina are basedon landforms: coastal (eastern), Piedmont,and mountain (western). More informationis available at the North Carolina Depart-ment of Transportation: Region: Coastal,www.ncdot.org/findInfo/coastal.html;Region: Piedmont, www.ncdot.orgfindInfo/piedmont.html; Region: Mountain, www.ncdot.org/findInfo/mountain.html.

9. North Carolina League of Munici-palities, About Cities and Towns, www.nclm.org/about%20cities%20and%20towns/about.htm.

10. U.S. Bureau of the Census, Census2000 Summary File 3 for North CarolinaPlaces, Table P53, Median Household In-come in 1999 (dollars), http://factfinder.census.gov/servlet/BasicFactsServlet.

11. Ester Cerin et al., “Destinations ThatMatter: Associations with Walking forTransport,” Health Place 13: 713–24(2007); Billie Giles-Corti et al., “IncreasingWalking: How Important Is Distance to,Attractiveness, and Size of Public OpenSpace?” American Journal of PreventiveMedicine 28(2S2): 169–76 (2005).

12. North Carolina Department of Trans-portation, Division of Bicycle and PedestrianTransportation, Bicycle and PedestrianPlanning Grant Initiative, www.itre.ncsu.edu/PTG/BikePed/NCDOT/index.html.

13. North Carolina State Center forHealth Statistics, Behavioral Risk FactorSurveillance System (BRFSS), Calendar Year2006 Results, www.schs.state.nc.us/SCHS/brfss/2006/index.html.

14. NCDOT, Bicycle and PedestrianPlanning Grant Initiative, www.itre.ncsu.edu/PTG/BikePed/NCDOT/index.html.

15. U.S. Bureau of the Census, Census2000 Summary File 3, http://factfinder.census.gov/servlet/BasicFactsServlet.