1. ¹Harvard School of Public Health, Boston, MA, USA
2. ²Purdue University, West Lafayette, IN, USA
3. ³Rails-to-Trails Conservancy, Washington, DC, USA

Correspondence: Angie L. Cradock, Department of Society Human Development, and Health at the Harvard School of Public Health, 677 Huntington Avenue, 7th Floor, Boston, MA 02115, USA. E-mail: acradock@hsph.harvard.edu

Abstract

Providing safe, convenient places for walking and bicycling can reduce barriers to participating in regular physical activity. We examined bicycle- and pedestrian-related investments authorized by federal transportation legislation in 3,140 counties in the United States by region, population size and urbanization, social and economic characteristics, and indicators of travel-related walking and bicycling. From 1992 to 2004, states and counties implemented 10,012 bicycle- and pedestrian-related projects representing $3.17 billion in federal expenditures. We found disparities in implementation and system-building outcomes according to population size and location and social and economic indicators. Counties characterized by persistent poverty (odds ratio=0.69, 95% confidence interval 0.53–0.91) or low educational status (odds ratio=0.66, 95% confidence interval 0.52–0.84) were less likely to implement projects. Three key policy recommendations for improving public health outcomes are drawn from this research: Improved data tracking, more explicit linkages between transportation projects and public health, and improved planning assistance to underserved communities are all seen as essential steps.