Next Article in Journal
Numerical Investigations through ANNs for Solving COVID-19 Model
Next Article in Special Issue
Implementation of Physical Activity Programs for Rural Cancer Survivors: Challenges and Opportunities
Previous Article in Journal
Collection of Data on Sex, Sexual Orientation, and Gender Identity by U.S. Public Health Data and Monitoring Systems, 2015–2018
Previous Article in Special Issue
What Sets Physically Active Rural Communities Apart from Less Active Ones? A Comparative Case Study of Three US Counties
Article

Do State Comprehensive Planning Statutes Address Physical Activity?: Implications for Rural Communities

1
Nelson Institute for Environmental Studies, University of Wisconsin-Madison, Madison, WI 53706, USA
2
School of Public Health, University of Illinois at Chicago, Chicago, IL 60612, USA
3
Department of Social and Behavioral Health Sciences, School of Public Health, West Virginia University, Morgantown, WV 26506, USA
4
Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL 60612, USA
*
Author to whom correspondence should be addressed.
Academic Editor: Paul B. Tchounwou
Int. J. Environ. Res. Public Health 2021, 18(22), 12190; https://doi.org/10.3390/ijerph182212190
Received: 1 November 2021 / Revised: 15 November 2021 / Accepted: 17 November 2021 / Published: 20 November 2021

Abstract

Less than one-quarter of U.S. adults meet physical activity (PA) recommendations, with rural residents less likely to be active than urban residents. The built environment has been identified as a potential facilitator of PA and local comprehensive plans are a foundational tool for guiding the development of the built environment. The purpose of this study was therefore to understand the current landscape of comprehensive planning state statutes related to PA and rural communities. We used primary legal research methods to identify, compile, and evaluate all 50 state comprehensive planning statutes for items related to PA and conditional mandates based on population size of local jurisdictions. The presence of population-conditional planning mandates and the inclusion of PA-related items was analyzed by state-level rurality using Fisher’s exact tests. Our analyses demonstrated that (1) broader PA-related items were addressed in state statutes more often than more specific PA-related items; (2) when PA-related items were addressed, they were most likely to be mandated, subsumed elements; (3) several PA-related items were less likely to be addressed in the most rural states and/or conditionally mandated for jurisdictions meeting minimum population requirements; and (4) only two states addressed PA directly and explicitly in their comprehensive planning statutes.
Keywords: physical activity; rural; policy; comprehensive plan; built environment; urban planning; state statute; legal epidemiology physical activity; rural; policy; comprehensive plan; built environment; urban planning; state statute; legal epidemiology

1. Introduction

Physical activity (PA) provides countless mental health [1] and physical health [2,3] benefits, but only 22.8% of adults in the United States (U.S.) meet the U.S. Department of Health and Human Service’s (DHHS) PA guidelines for achieving those health benefits [4]. Although this figure has improved over recent years, rural residents lag behind urban residents: 19.6% of rural residents and 25.3% of urban residents meet DHHS PA guidelines [5]. While a wide array of PA barriers and facilitators have been reported in the literature [6,7,8], a systemically equitable [9] and potent facilitator [10] is a built environment conducive to PA.
Socioecological theory outlines the crucial role of the policy and built environment in creating active communities [11,12,13]. Creating PA-friendly environments has become a priority for reaching global public health, economic development, and sustainability goals [12,14,15,16]. Researchers have identified many specific built environment features and characteristics associated with increased PA [17,18,19], including bicycling infrastructure [20], mixed-use land development [19,21], increased residential density [19], and access to parks and recreation [19].
However, rural built environments may be less likely to promote PA than urban ones. Rural environments present unique barriers to PA, including lower residential and job density, fewer facilities for recreational PA and lack of public transportation to and from such facilities, fewer destinations in town centers, lack of pedestrian infrastructure, high-speed and heavy commercial traffic, and fear of wild and domestic animals [22,23,24,25,26]. Despite the unique environmental barriers to PA that rural residents face and the urban–rural disparity in PA, research on planning for active living has largely focused on urban environments [27].
Local governments—whether in urban, suburban, or rural communities—are uniquely situated to facilitate the development of healthy built environments through local planning and built environment policies. In collaboration with local residents, policymakers, and other stakeholders, local planners (e.g., planning consultants, staff planners, regional planners) define a vision for the development of a community’s built environment and identify goals, policies, and actions that the community can take to make that vision a reality [28,29]. Such policies and actions might include the creation of community design guidelines, tax incentive programs for certain types of development, and capital investment plans, among others. This vision and the ensuing goals, policies, and actions are often encoded in a comprehensive plan [29,30,31].
Comprehensive plans cover a wide range of topics, including transportation, economic development, and housing. They are often considered the foundational document of local planning practice, making them important policy levers for addressing cross-departmental, intersectoral, and systemic issues like health equity and PA promotion [28,32,33]. In many cases, comprehensive plans directly impact built environment policies like zoning codes through consistency requirements [34,35].
The literature evaluating PA-promoting components of comprehensive plans is still emerging. In 2010, an American Planning Association (APA) survey of 890 local planners and officials found that 57.1% of adopted comprehensive plans addressed active living in some way [36]. A 2014 survey of local officials in the U.S. found that approximately three-fourths (78%) of comprehensive plans included at least one of three active living goals or objectives: implementation of a Complete Streets policy, development of street connectivity, or encouragement of mixed-use development [37]. Several studies have found that active living policies and programs are enacted more consistently when they are included in comprehensive plans [38,39], and others have shown that the incorporation of active living components in comprehensive plans and zoning ordinances is associated with higher PA levels, reduced PA disparities, and even lower cancer incidence [9,40,41,42,43,44,45].
Comprehensive plans may be particularly powerful tools for rural communities to address lack of PA through built environment interventions; however, comprehensive plans are less prevalent and less likely to include PA-promoting goals and policies in rural communities [37]. One reason for this may be variation in how state comprehensive planning statutes address rural communities and PA. While the specific content (and presence) of a comprehensive plan is largely driven by local leadership and public input, state statutes enabling comprehensive planning also play a role. The Standard City Planning Enabling Act (SCPEA) of 1927 attempted to standardize state planning statutes; however, it was not uniformly adopted by the states [46]. Other model planning laws and regulations, or portions thereof, have also been adopted by various states over the years [46,47,48]. This has resulted in wide variability in comprehensive planning enabling acts among states, both in terms of required planning processes and required plan content. Strong state comprehensive planning mandates are associated with the presence of a locally adopted comprehensive plan and higher-quality comprehensive plans [49,50].
To our knowledge, an up-to-date evaluation of comprehensive planning state statutes focused on components that are likely to promote PA does not exist. The APA has surveyed state comprehensive planning enabling statutes with a focus on requirements for hazard mitigation [34] and housing [51] elements. In addition, the Growing Smart Legislative Guidebook, published by the APA in 2002, included an evaluation of state comprehensive planning statutes. This evaluation addressed how much statutes differ from the SCPEA; whether the statutes mandate, conditionally mandate, or encourage comprehensive planning; the extent to which statutes address 20 types of broad plan elements, including land use, recreation, transportation, and historic preservation; and the strength of the state’s role in supporting local planning [47]. This evaluation also noted to which types of jurisdictions (e.g., towns, villages, cities, counties) comprehensive planning mandates are applied [47]. However, past evaluations have not analyzed state statutes with a focus on implications for rural communities.
The purpose of this study was therefore to understand the current landscape of comprehensive planning state statutes related to PA and rural communities. This study seeks to characterize the extent to which state comprehensive planning statutes address PA-related elements and topics, if and how the laws apply differently to rural versus urban communities, and how these characteristics vary by state-level rurality. To our knowledge, this is the first comprehensive 50-state evaluation of the statutory requirements for local plans to include information on transportation, land use, parks and recreation, PA, and equity, and to focus on implications for comprehensive planning in rural communities.

2. Methods

2.1. State Statute Identification and Coding Protocol

We used primary legal research methods [52,53] to identify and compile codified state statutory laws for each of the 50 states using state law databases available via the commercial legal research service LexisNexis [54]. Following well-established policy surveillance methods [55], we systematically searched each state’s statutes using Boolean keywords as well as line-by-line reviews of the indices and tables of contents to locate relevant components of the codified statutes that were on-the-books as of January–February 2021.
A detailed coding protocol was established to guide the review and coding of each state’s statutes and to ensure consistency in the process. While coding, we tracked ambiguities in the language of the state laws and met regularly to discuss such instances. We reached consensus in coding decisions based on the letter of the law, combined with the team’s expertise in planning, land use, and PA-related issues. All such decisions were documented, and state laws were re-reviewed in instances where a decision led to a potential for inconsistency across states. Where possible, we also verified the contents of state laws against a publicly available secondary source from the APA [34], which contained historical information on relevant state laws, and previously compiled but unpublished data from a member of the study team (J.F.C.).
We excluded codified state laws from the analysis that addressed non-mandatory regional and/or joint planning and home rule charters. Due to resource limitations, we excluded codified state regulations—even if they were embedded by reference into a codified state statute—and non-codified state policies. One study author (C.M.), a trained legal researcher, reviewed all relevant state laws under the direction of another study author (J.F.C.) with extensive policy surveillance experience.

2.2. State Statute Variables

Several characteristics of the state statutes were evaluated with regard to the current study: (1) requirements or encouragement to include any of 19 items related to PA in comprehensive plans (described in more detail in the following sub-sections and listed in Appendix A); (2) whether these items were discussed as primary elements, subsumed elements, or topics; and (3) the nature of conditional mandates to develop comprehensive plans and to include items related to PA in the plan.

2.2.1. Required or Encouraged Items Related to PA

The state laws were qualitatively reviewed for whether and under what circumstances a county or municipality is required to include in its plan information on the following 19 items: PA, equity, bicycle/pedestrian, bicycling, pedestrian, public transportation, land use, streets, transportation/circulation, design, infill/reuse, mixed use, smart growth, farmland preservation, historic preservation, parks/recreation, open space, trails, and natural resources. A list of PA-related comprehensive plan items was developed by consulting two validated comprehensive plan toolkits of evidence-informed active living strategies, “Healthy Living and Active Design: A Scorecard for Comprehensive Plans” [56] and “Healthy Rural Community Design: A Scorecard for Comprehensive Plans” [57]. This list was refined to the final list of 19 items through discussion with the research team. A detailed codebook for these items is included in Appendix A.
Each item that was included in a state law was also coded by the strength of the requirement—as mandated (strongest), conditionally mandated, or encouraged (weakest). Items required by law to be included in a plan were coded as mandated. Items required by law to be included in a plan if certain criteria were met (e.g., population minimum) were coded as conditionally mandated. Items not required by law to be included in a plan, but that were mentioned in the law or suggested to be included, were coded as encouraged.
For each of the 19 PA-related items, a four-level variable was created with values “Mandated”, “Conditionally mandated”, “Encouraged”, and “Not Addressed”. A binary summary variable was also created, taking values “Yes” (the item was addressed in the state statute as mandated, conditionally mandated, or encouraged) and “No” (the item was not addressed in the state statute). Each of the 19 items could be included in multiple sections of a state statute and thus coded multiple times. We retained only the instance with the strongest requirement. For example, a state statute could have mandated the item “bicycling” in one section and also encouraged it elsewhere; it would have been coded only once for that state, as “mandated”.

2.2.2. Primary Elements, Subsumed Elements, and Topics

In addition to whether PA-related items were mandated, conditionally mandated, or encouraged, we wanted to know whether these items were discussed as primary elements, subsumed elements, or as topics. For each of the 19 PA-related items that we initially coded as included in the statute, we further coded the item as a “primary element” if it was treated by state law as a distinct section of a plan (either through use of language such as element, plan, chapter, component, or section; or through placing the item in a list of other items referred to as elements, plans, etc.). We coded the item as a “subsumed element” if it was treated by state law as information to include within or as part of a primary element. For instance, for a law providing that a plan shall include “a land use element designating the proposed general distribution and general location and extent of the uses of land…for…recreation, open spaces…”, land use was coded as a primary element, and parks/recreation and open space were each coded as subsumed elements. We coded the item as a “topic” if a state law discussed its inclusion in a plan, but not as a primary or subsumed element. For instance, for a law providing that the plan “may provide for…energy conservation, transportation… and recreational…opportunities”, conservation/natural resources, transportation, and parks/recreation were coded as topics. For each of the 19 PA-related items, three binary variables were created (which took the values “Yes” and “No”), representing the categories: primary element, subsumed element, and topic.

2.2.3. Conditional Mandates

The state laws were qualitatively reviewed for whether and under what circumstances a county or municipality is required to develop and adopt a comprehensive plan. Laws that required a county or municipality to plan or provide for planning if certain criteria were met (e.g., population minimum) were coded as conditionally mandated. The nature of each conditional mandate was then evaluated and thematically coded into broad categories by the first author (L.M.C.). Binary variables were created for each of several conditions put on mandates to develop a comprehensive plan (e.g., population minimum, presence of a plan commission) that took the values “Yes” and “No”. We primarily present results for population-based conditional mandates because this is the closest proxy for conditional mandates based on rurality of local jurisdictions.
Binary variables were also created for each PA-related item representing the presence (“Yes”) or absence (“No”) of a population-conditional mandate to include that item.

2.3. State-Level Rurality

State-level rurality was defined as the percent of the state population living outside of a 2010 U.S. Census Bureau defined Urban Area [58], from which a categorical variable was created using tertiles. These categories are labelled “Least Rural” (n = 16, ≤16.70% rural population), “Mixed Rural/Urban” (n = 17, 16.71–33.67%), and “Most Rural” (n = 17, ≥33.68%).

2.4. Data Analysis

Descriptive statistics were obtained for the characteristics of interest based on the review and coding of the state statutes. We analyzed the number and percentage of states that mandated, conditionally mandated, and encouraged the inclusion of each of the 19 PA-related items; the number and percentage of states that addressed each of the 19 PA-related items as primary elements, subsumed elements, and topics; the number and percentage of states that had a mandate for comprehensive planning conditioned on the population of the local jurisdiction; and the number and percentage of states that had population-conditional mandates for any of the PA-related items. Furthermore, among states that addressed each of the 19 PA-related items, we calculated the percentage that had population-conditional mandates.
The presence of population-conditional planning mandates and the inclusion of PA-related items was further analyzed by state-level rurality. Fisher’s exact tests were used to test associations between the binary state statute variables (presence or absence of a certain characteristic) and state-level rurality. The Fisher’s exact tests in this study test the null hypothesis that the percentage of states that have the characteristic in question does not differ between the three levels of rurality. Although these data represent a census rather than a sample, Fisher’s exact tests are appropriate because of the small number of observations and small expected values in the contingency tables [59]. All data analysis was conducted using Stata 16.1 (StataCorp, College Station, TX, USA) [60].

3. Results

All 50 states had laws regarding comprehensive planning for counties, municipalities, or both. Two states, Georgia and Oregon, did not discuss any required or encouraged items in their comprehensive planning state statutes; however, these states are retained in the denominator of the data because they did have comprehensive planning statutes on the books.

3.1. Requirements and Encouragement for Items Related to PA

The prevalence of PA-related items in the state statutes varied widely, as shown in Table 1.
Five items were addressed in at least 70% of state statutes: parks/recreation was discussed in 90% of states, land use in 88%, transportation/circulation in 80%, streets in 74%, and natural resources in 74%. On the other hand, eight items were addressed in less than 25% of the state statutes: PA (4% of states), smart growth (8%), bicycle/pedestrian (14%), infill/reuse (16%), mixed use (16%), pedestrian (18%), trails (20%), and bicycling (22%). With a few exceptions, when items related to PA were addressed in state statutes, they were most likely to be mandated rather than conditionally mandated or encouraged. The items most frequently mandated were land use (64% of states), transportation/circulation (50%), parks/recreation (46%), and streets (44%). As compared to mandated and encouraged items, relatively few states conditionally mandated items, with the notable exception of the transportation/circulation item (24% of states conditionally mandated).
Table 2 presents the 19 items of interest displayed by element/topic types rather than level of mandate (and, unlike the categories in Table 1, the categories in Table 2 are not mutually exclusive).
Most of the PA-related items were more likely to be addressed in state statutes as a subsumed element rather than a primary element or a topic. The notable exceptions were transportation/circulation, land use, and natural resources, which were more likely to be addressed as primary elements; and equity, which was more likely to be addressed as a topic. Many PA-related items addressed as subsumed elements were subsumed under several different primary elements. Often, PA-related items were addressed as subsumed under primary elements that were outside the scope of this analysis (i.e., primary elements not related to PA).

3.2. Differing Comprehensive Planning Mandates Based on Local-Level Rurality

The closest indicator of differing comprehensive planning requirements for rural versus urban communities we observed in the state statutes was conditional mandates based on population of the county or municipality. Out of the 50 states, only five—Colorado, Nevada, Washington, Oklahoma, and Nebraska—had population-conditional mandates for both comprehensive planning and for PA-related elements/topics. Four states—Massachusetts, Kentucky, Pennsylvania, and Minnesota—had population-based conditional mandates only for comprehensive planning generally, while four other states—Delaware, Florida, Arizona, and Utah—had population-based conditional mandates for PA-related plan elements/topics only. The language for each of these state’s population-conditional laws can be found in Appendix B. Figure 1 visualizes these results and shows that the states with population-conditional mandates are diverse with regard to geographic location.
There was no discernible pattern to population-conditional mandates for comprehensive planning based on state-level rurality, though there was for population-conditional mandates for PA-related items. Of the nine states with population-conditional mandates for incorporating PA-related items, six (66.7%) were in the least rural states. The Fisher’s exact test for an association between state-level rurality and population-conditional mandates on PA-related items yielded a p-value of 0.072.
Some PA-related items were more likely to have mandates based on population size than others. Table 3 shows the prevalence of states with population-conditional mandates regarding each item (col 2) as compared to the number of states that addressed the item at all in their planning statutes (col 3). It also includes the percentage of states with population-conditional mandates for each item over the total number of states that address that item (col 4).
In absolute terms, the items that were discussed in the greatest number of state statutes were also the ones that had population-conditional mandates in the greatest number of states. These include parks/recreation (seven states with conditional mandates), open space (six), land use (six), transportation (five), and streets (five). However, for five items, at least one in five states that addressed the item put population-based conditions on requiring that item in comprehensive plans: bicycle/pedestrian (28.6%), mixed use (25.0%), smart growth (25.0%), open space (20.0%), and trails (20.0%).

3.3. Differences in PA-Related Elements and Topics Based on State-Level Rurality

Table 4 shows the prevalence and percent of states addressing PA-related comprehensive plan items by state-level rurality. The table also shows the result of the Fisher’s exact test for any relationship of each item with state-level rurality.
For most items, there is no statistical relationship. That is, the rurality of a state’s population is not associated with the inclusion of many PA-related items in comprehensive planning statutes. There are, however, a few exceptions. For transportation/circulation (p = 0.038), public transportation (p = 0.074), mixed use (p = 0.001), infill/reuse (p = 0.023), smart growth (p = 0.008), and PA (p = 0.098) there was an association between the item and state-level rurality. Most of these items were addressed most frequently in the least rural states and equally infrequently in the mixed rural/urban or most rural states whereas public transportation was addressed less frequently with increasing rurality.

4. Discussion

PA provides many health benefits and local governments are well-situated to facilitate such activity through thoughtful comprehensive planning intended to create environments conducive to PA. The process and content of comprehensive planning is guided by state statutes that vary across the 50 states in the U.S. This study sought to evaluate state-level policies guiding the process of local comprehensive planning and the PA-related content of those plans, with particular attention paid to implications for rural jurisdictions.

4.1. Findings

This is the first 50-state review of the statutory requirements for local comprehensive plans to include information on transportation, land use, parks and recreation, PA, and equity, and the first review of state statutes to focus on differing comprehensive plan requirements by rurality. Our analyses demonstrated (1) broader PA-related items were addressed in state statutes more often than more specific items directly related to PA; (2) when PA-related items were addressed, they were most likely to be mandated, subsumed elements; (3) several PA-related items were less likely to be addressed in the most rural states and/or only conditionally mandated for jurisdictions meeting minimum population requirements; and (4) only two states addressed PA directly and explicitly in their comprehensive planning statutes.

4.1.1. PA-Related Items in State Statutes

When states did address items related to PA in their comprehensive planning statutes, they were more likely to address broad topics than specific strategies to promote PA. Of the 19 items analyzed, the most commonly required or encouraged items relevant to PA were parks and recreation (90% of states), land use (88%), transportation (80%), streets (74%), and natural resources (74%). State statutes can facilitate long-term built environment change in communities by mandating or encouraging the inclusion of PA-related items in comprehensive plans. Built environment approaches that combine transportation and land use changes are recommended by the Community Preventive Services Task Force, and the Task Force encourages planners to consider such strategies [19]. However, apart from parks and recreation, the PA-related items most likely to be addressed in statutes are so broad that they could be included in a plan without encouraging PA at all. For example, a community could include a transportation or streets chapter in their comprehensive plan that focuses completely on automobiles to the exclusion of bicyclist and pedestrian transportation considerations. Land use could be discussed in such a way that promotes segregated land uses and suburban sprawl rather than mixed-use and compact development. Many of the infrastructure and planning strategies that have been more specifically and directly linked to promoting PA [18,19,22,61,62,63,64,65] were required or encouraged in less than one quarter of state statutes: smart growth (8%), bicycle/pedestrian (14%), infill/reuse (16%), mixed use (16%), pedestrian (18%), trails (20%), and bicycling (22%).
When they were addressed at all, most of the PA-related items were more often addressed as subsumed elements rather than as primary elements or topics. Most of the PA-related items we analyzed may simply be too narrow to merit their own chapter or section of a comprehensive plan; indeed, the items that were more likely to be included as primary elements are some of the broadest of the items (i.e., transportation/circulation, land use, and natural resources). It is encouraging that when the PA-related items were addressed in state statutes, they were most often mandated rather than conditionally mandated or encouraged. This indicates that, while many of the PA-related items may not be deemed broad, complex, or important enough to merit their own chapter or section of the comprehensive plan, they still merited a mandatory sub-section of a chapter.
The notable exceptions to this typology were public transportation, farmland preservation, design, mixed use, and trails, which were all more likely to be encouraged than mandated or conditionally mandated; and equity, which was more often mandated, but as a topic rather than a subsumed element. These are important areas for PA-promotion and states may therefore consider being more prescriptive on these elements in state statutes.

4.1.2. Comprehensive Planning and PA-Related Items by State- and Local-Level Rurality

Six items were less likely to be addressed by statutes in states with higher rural populations: transportation, public transportation, mixed use, infill/reuse, smart growth, and PA. In addition, at least one in five states that addressed several of the PA-related items had population-minimum requirements for including that item in local comprehensive plans: bicycle/pedestrian (28.6% of state statutes that addressed the item had a population-minimum mandate), mixed use (25.0%), smart growth (25.0%), open space (20.0%), and trails (20.0%). These items, therefore, may be less likely to be addressed in rural, local comprehensive plans across the U.S.
There may be the notion among policymakers and planners that these PA-related items are not relevant to rural places. However, public transportation is particularly important in rural communities, which have an increasingly large share of older (65+) residents who may have trouble accessing community services and resources [66,67]. While it may seem that rural residents have the private recreational resources (i.e., large lots) necessary to be physically active, studies have found that lack of access to public spaces for recreation and social isolation are barriers to PA in rural communities [22,27]. Therefore, trails, open spaces, and other public places for PA may be especially important facilitators in rural communities. Trails, moreover, have been identified as one of the most effective strategies for rural communities to promote active transportation and recreation, while also building recreational tourism [22,27,68,69]. Lastly, when implemented in a context-sensitive way, mixed use, infill/reuse, smart growth, and open space planning can help rural communities preserve rural land, control infrastructure costs, and maintain a small-town character and sense of community, while also promoting PA [57,68]. Along with the built environment strategies discussed above, PA itself is important for rural communities to explicitly address comprehensive plans because it is less prevalent in rural adults than urban adults [5,70].
Thirteen states (26%) had conditional mandates based on population for local-level comprehensive planning (four states), for the incorporation of any of the PA-related items in local comprehensive plans (four states), or both (five states). Population-based conditional mandates for PA-related items (but not for comprehensive planning in general) were more likely in the least rural states and they varied greatly in their complexity. For example, Delaware’s population-conditional mandate for PA-related items is for municipalities with 2000 or more population. On the other hand, Arizona had different population thresholds for different items, ranging from 2500 to 200,000+ population minimums. Several states combined their population-based mandate with another condition. Arizona, Colorado, and Washington had multi-part conditional mandates based on a combination of minimum population size and minimum population growth rates. Kentucky, Massachusetts, Minnesota, Nevada, Oklahoma, and Washington combined population-based conditions and conditions based on the presence of a planning commission or agency. Often, comprehensive planning and/or the inclusion of PA-related items was encouraged for jurisdictions in which it was not mandated. Other states had standalone conditional mandates based on the presence of a planning body; the desire to zone; minimum population growth rates; if the jurisdiction’s comprehensive planning process was funded by a state grant; and vague conditions like “where pertinent”, “as appropriate to the municipality”. These conditions may be less likely to apply to rural communities as well as the population-minimum conditions (e.g., if the jurisdiction does not have the capacity to staff a plan commission or if they choose to not zone because of lack of development pressure).
Rural communities may have less capacity and funding to prepare a comprehensive plan [57,71] and states with higher rural populations may face political opposition to strong comprehensive planning laws, particularly ones that advocate for policies like smart growth [72]. Conditional mandates based on population and the fact that the most rural states were less likely to address several PA-related items might stem from these challenges. However, comprehensive plans can be powerful tools for communities to determine the direction of future development and to address, in a proactive and context-sensitive way, their most pressing social, economic, and health challenges. Allowing rural communities to opt out of comprehensive planning or including PA-related items in their comprehensive plan does not set them up to face these challenges and may even contribute to the rural–urban PA disparity [5].
PA and built environment strategies that promote PA are just as important in rural communities as they are in urban ones. Addressing PA-related items in state comprehensive planning statutes could create important local-level policy and built environment changes, and these changes should not be limited to urban areas. However, states should also be aware that planning for PA is a context-sensitive practice; built environment policies to promote PA will look different in rural versus urban communities [27]. Local governments are well-situated to understand and address the unique needs of their individual communities, but they may need a push from state law to consider certain topics in their comprehensive plans. Therefore, comprehensive plan enabling state statutes should strike a balance between (a) mandating inflexible PA-promoting planning policies that are neither appropriate, effective, nor feasible in rural communities, and (b) offering so much flexibility (or mandates conditioned on population) that rural communities omit policies that can promote PA. Creating technical assistance programs and grant funding for comprehensive planning processes may also help rural communities meet such mandates.

4.1.3. PA Language in State Statutes

PA itself was only discussed in two states. We quote these state statutes below in order to provide instructive examples of policy language. California’s state statutes conditionally mandated a subsumed element about PA for both county and municipal comprehensive plans, under a mandated primary “environmental justice element”. They stipulated:
“(h)(1) An environmental justice element, or related goals, policies, and objectives integrated in other elements, that identifies disadvantaged communities within the area covered by the general plan of the city, county, or city and county, if the city, county, or city and county has a disadvantaged community. The environmental justice element, or related environmental justice goals, policies, and objectives integrated in other elements, shall do all of the following:
(A)
Identify objectives and policies to reduce the unique or compounded health risks in disadvantaged communities by means that include, but are not limited to, the reduction of pollution exposure, including the improvement of air quality, and the promotion of public facilities, food access, safe and sanitary homes, and physical activity” [73].
Washington encouraged a subsumed element related to PA in both county and municipal comprehensive plans, under the conditionally mandated primary land use element. Its law stipulates: “Wherever possible, the land use element should consider utilizing urban planning approaches that promote physical activity” [74].

4.2. Strengths, Limitations, and Future Research

This study has several strengths. State statutes were identified through primary legal research methods, objectively coded by a legal researcher, and reviewed by the research team. Therefore, this study is not impacted by self-report or coder bias regarding the content of state statutes. In addition, we report information on a broad variety of PA-related items rather than a few items in one domain of PA (e.g., active transportation or parks). This allows us to take a broader view of PA and built environment aspects. Lastly, and perhaps most importantly, this study is novel. To our knowledge, this is the first 50-state review of the statutory requirements for local comprehensive plans to include information on transportation, land use, parks and recreation, PA, and equity, and the first review of state statutes to focus on differing comprehensive plan requirements by rurality.
Despite these strengths, there are several limitations to the present study. This is a cross-sectional study; therefore, relationships between state-level rurality and state statutes should be interpreted with caution. Conducting Boolean keyword searches of state statutes (combined with reviewing statutory indices and tables of contents, and continually reviewing coding protocol) is the best-practice method in policy surveillance that nevertheless has limitations [55,75]. There is the potential that we overlooked certain “wordings” that correspond to important PA-related content of the state statutes.
We only evaluated state comprehensive planning statutes and not regulations or government programs. Therefore, there may be other state-level laws (i.e., rules, regulations, and non-codified policies) regarding comprehensive planning that were not accounted for in this study. In addition, when evaluating comprehensive planning mandates and PA-related items, we did not take into account the diversity of consistency requirements, enforcement procedures, and encouragement mechanisms among states. These other state-level policies could impact the extent to which comprehensive planning mandates are taken up by local governments and therefore, should be the focus of future research. In particular, a combination of quantitative and qualitative research on differential enforcement and encouragement mechanisms for urban versus rural communities could shed light on how state-level comprehensive planning statutes translate to local-level planning efforts (and subsequent built environment changes) in different contexts.
Moreover, while there is evidence that strong comprehensive planning mandates do result in more and stronger comprehensive plans [50,76], state-level policies are only one factor influencing the presence and quality of local comprehensive plans. State and regional planning infrastructure, culture, and history, as well as local economic conditions, level of development pressure, capacity for planning, politics, and community support can all impact whether a comprehensive plan will be drafted and what it will contain. In addition, the extent to which comprehensive plans are implemented once adopted remains a question in the literature [30]. Therefore, more proximal research should be conducted to investigate when, how, and why rural jurisdictions incorporate PA-related items into their comprehensive plans, what role state comprehensive planning statutes play in the decision to include PA-related items, and what the long-term outcomes are of such incorporation (i.e., changes to the built environment, health behaviors, health outcomes). Lastly, longitudinal research could be targeted to the two states (California and Washington) that included PA in their comprehensive planning statutes to understand if this has led to PA being incorporated in local plans.
Our systematically-developed database of state comprehensive planning statutes can serve in the design and analysis of future research projects. In particular, comparative work based in different characteristics of state statutes should be conducted. This could help ascertain the role of state planning policy in influencing local-level planning policy, built environments, health behaviors, and health outcomes. For example, we found that several items most closely associated with PA promotion (smart growth, bicycle/pedestrian, infill/reuse, mixed use, pedestrian, trails, and bicycling) were encouraged or required in less than one-quarter of state statutes. Researchers could compare local-level comprehensive plans from states that do and do not mandate these items; this analysis could further be stratified by rurality to understand how state-level planning policy is implemented across contexts. In addition, researchers could compare the presence and quality of local-level plans across varying local contexts in states that do and do not have conditional mandates for planning and/or PA-related items.

5. Conclusions

Comprehensive planning can be a way for all communities—whether small town or large metropolitan—to develop a PA-friendly built environment. As states update comprehensive planning statutes, lawmakers should carefully consider including requirements for elements and/or topics specifically and directly related to the promotion of PA, or even, following the example of California and Washington, addressing PA itself. These requirements should apply to rural communities as well as urban ones, but they should be written in such a way that they can be applied in a locally-driven, context-sensitive manner. Comprehensive planning and PA-promoting built environment strategies may help rural communities not only address low community rates of PA, but also face their many social, economic, and health challenges. States may therefore also want to consider—and include language in their statutes pertaining to—the myriad co-benefits that are likely to arise from planning policies that promote PA, including economic, sustainability, community cohesion, and other health benefits [16,77]. Finally, states should strongly consider implementing technical assistance and funding programs to help rural communities develop comprehensive plans.

Author Contributions

Conceptualization, L.M.C., C.G.A., S.I.M. and J.F.C.; methodology, J.F.C., C.G.A. and L.M.C.; formal analysis, L.M.C.; investigation, C.M.; resources, J.F.C.; data curation, C.M. and L.M.C.; writing—original draft preparation, L.M.C., S.I.M. and C.M.; writing—review and editing, L.M.C., C.G.A., J.F.C., S.I.M. and C.M.; visualization, L.M.C.; project administration, L.M.C. All authors have read and agreed to the published version of the manuscript.

Funding

Support for J.F.C., C.M. and S.I.M. was provided by Cooperative Agreement Number U48DP006381 from the Centers for Disease Control and Prevention.

Data Availability Statement

The data presented in this study will be openly available in FigShare at DOI https://doi.org/10.6084/m9.figshare.15057468 after a 1-year embargo. Please contact the corresponding author for requests to access the data before the 1-year embargo has expired. The codebook for the dataset can be found at https://doi.org/10.6084/m9.figshare.15057426.

Acknowledgments

This work is a product of the Rural Active Living Workgroup of the Physical Activity Policy Research and Evaluation Network (PAPREN), a thematic network of the Centers for Disease Control and Prevention’s Prevention Research Center network. PAPREN is an applied research and evaluation network focused on identification and implementation of local, state, and national policy approaches that influence opportunities for physical activity and built environment strategies. The findings and conclusions in this paper are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Conflicts of Interest

C.G.A. is a co-chair of and S.I.M. is the fellow for the PAPREN Rural Active Living Work Group. J.F.C. is co-PI of PAPREN and co-chair of the PAPREN Equity and Resilience Workgroup.

Appendix A

Table A1. Coded language for each physical activity (PA)-related item identified in state statutes.
Table A1. Coded language for each physical activity (PA)-related item identified in state statutes.
ItemCoded Language
Transportation
Bicycle/Pedestrian
  • “bicycle and pedestrian ways”
  • “bicycle, pedestrian facilities”
  • “pedestrian and bicycle travel”
  • “bicycling and pedestrian access and travelways”
  • “paths for bicycles and pedestrians”
  • “pedestrian and bicycle projects”
  • “pedestrian and bikeway systems”
  • “pedestrian and bicycle component”
Bicycling
  • Bicycle accommodations
  • Bicycle facilities
  • Bicycle paths
  • Bicycle routes
  • Bicycling routes
  • Bikeways
  • Multimodal transportation network that meets the needs of bicyclists
Pedestrian
  • Multimodal transportation network that meets the needs of pedestrians
  • Pedestrian
  • Pedestrian accommodations
  • Pedestrian-oriented development
  • Pedestrian ways
  • Walking
Public transportation
  • Ground rapid transit systems
  • Transit
  • Mass Transit
  • Mass Transportation
  • Multimodal transportation network that meets the needs of users of public transportation
  • Public Transit
  • Public transportation facilities
Streets
  • Arterials
  • Boulevards
  • Freeways
  • Highways
  • Master street plan
  • Parkways
  • Public ways
  • Rights-of-way
  • Roads
  • Road network
  • Streets
  • Thoroughfares
Transportation/Circulation
  • Circulation
  • Circulation plan
  • Mobility
  • Multimodal circulation
  • Multimodal transportation
  • Plan for movement of people and goods
  • Traffic circulation and transportation systems
  • Transportation
  • Transportation facilities
  • Transportation plan
  • Transportation routes
  • Transportation system
  • Transportation terminals and lines
Land Use
Land use
  • Designation of areas for various types of public and private development and use
  • Land and water use
  • Land classification and utilization
  • Land use
  • Land uses
  • Land utilization
  • Use of land
  • Uses of land
Design
  • Aesthetics
  • Characteristics and community aesthetics important to future development
  • Civic design
  • Community design
  • Design for subdivisions and unimproved land and areas subject to redevelopment
  • Design guidelines
  • Urban design
  • Urban form and design
Infill/Reuse
  • Infill
  • Redevelopment of vacant sites
  • Reuse
Mixed use
  • Mix of uses
  • Mixed land use
  • Mixed use
  • Mixture of land uses
Smart growth
  • Compact development
  • Compact form development
  • Discourage urban sprawl
  • Smart growth
Farmland preservation
  • Agricultural preservation
  • Agriculture protection area
  • Conservation and restoration of existing farmlands
  • Consideration of areas most suited for agricultural uses
  • Discouragement of incompatible development in rural areas, including identifying critical rural areas
  • Farmland preservation
  • Preservation and protection of agricultural resources
  • Preservation of character and density of rural neighborhoods
  • Preservation of prime agricultural lands
  • Preserves agricultural areas and activities, including prime farmlands and soils
  • Protection of prime agricultural and forestlands
  • Protection of agricultural land
  • Protection of agricultural resources
  • Protection of rural character of an area
Historic preservation
  • Areas; sites; and structures of historical, archeological, and architectural significance
  • Conservation and restoration of historical resources
  • Distribution and suitable uses of land, including historic areas
  • Historic district boundaries/designated historically significant properties meriting protection
  • Historic preservation
  • Historical and archeological resources
  • Historical preservation
  • Identification of historically significant and other housing for purposes of conservation
  • Preservation of historical features, sites, and monuments
  • Preservation of rare and irreplaceable historic features and resources
  • Preservation of historic places
  • Protection of historic resources
Parks & Recreation
Parks/Recreation
  • Parkland
  • Parks
  • Parks and recreation
  • Playfields
  • Playgrounds
  • Recreation
  • Recreational and tourism uses
  • Recreational facilities
  • Recreational land uses
  • Recreational resources
Open space
  • Open development areas
  • Open space areas
  • Open spaces
Trails
  • Hiking trails
  • Paths
  • Riding trails
  • Trail systems
  • Trails
  • Trailways
Natural resources
  • Areas; sites; and structures of ecological and wildlife significance
  • Conservation
  • Conservation and preservation of traprock and other ridgelines
  • Conservation easements
  • Conservation of forest lands
  • Conservation of living and nonliving coastal zone resources
  • Conservation of energy, water, soil, and agricultural and mineral resources
  • Conservation of land and other irreplaceable natural resources
  • Conservation of natural environment
  • Conservation of natural resources
  • Conservation of water and energy
  • Conservation of water resources
  • Conservation programs
  • Conservation use and protection of natural resources
  • Conserve significant natural resources
  • Efficient use of energy
  • Endangered or threatened species
  • Energy conservation
  • Minimizing development in sensitive shoreland areas
  • Natural resources
  • Nature preserves, wildlife management areas, and national forests
  • Preservation
  • Preservation of natural features, sites, and monuments
  • Preservation of rare and irreplaceable natural areas
  • Protection of critical waterfront areas
  • Protection of environmental assets
  • Protection of significant natural resource areas
  • Protection of sensitive areas
  • Protection of the quality and quantity of groundwater
  • Renewable energy
  • Sensitive areas
  • Soil conservation
  • Water conservation
Other Relevant
Physical activity
  • Physical activity
Equity
  • Affordable housing
  • Cost-burdened households
  • Disabled Persons
  • Disadvantaged community
  • Disadvantaged populations
  • Equal provision for the housing needs of all segments of the community regardless of race, color, creed, or economic level
  • Elderly
  • Elimination of substandard dwelling conditions
  • Elimination of slums/blighted areas
  • Housing affordability
  • Housing quality, variety, and affordability
  • Housing needs of residents earning less than 80% of the area median income
  • Improvement of housing quality, variety, and affordability
  • Improvement of housing standards
  • Low-cost conventional housing
  • Low Income Persons/Households
  • Moderate income housing
  • Older persons
  • Persons with a disability
  • Populations without automobiles/communities with limited [transportation] mode choice
  • Redevelopment or rehabilitation of blighted areas
  • Rehabilitation of housing in declining neighborhoods
  • Replanning of blighted districts and slum areas
  • Special housing needs (elderly, disabilities, large families, farmworkers, families with female heads of households, and families and persons in need of emergency shelter)
  • Special needs
  • Special needs of the transportation disadvantaged
  • Special needs housing
  • Special populations
  • Unserved broadband areas

Appendix B

Table A2. Population-based conditions on comprehensive planning mandates and rules addressing comprehensive plan elements or topics related to physical activity (PA), organized by state-level rurality.
Table A2. Population-based conditions on comprehensive planning mandates and rules addressing comprehensive plan elements or topics related to physical activity (PA), organized by state-level rurality.
StateConditions for Planning MandatesConditions for Elements/Topics
Least Rural
Arizona
  • Counties with 200,000+ population; otherwise encouraged.
  • Counties with 125,000+ population; otherwise encouraged.
  • Cities with 50,000+ population; otherwise encouraged.
  • Cities and towns with 2500–10,000 population that have had a population increase average >2% per year for a 10-year period before the most recent US census AND cities and towns with >10,000 population; otherwise encouraged.
Colorado
  • (I) City & county or county with 10,000+ population and a population increase of either (a) 10%+ from 1994 to 1999, or (b) 10%+ during any 5-year period ending in 2000 or any subsequent year, AND (II) city & county or county with 100,000+ population; otherwise encouraged.Municipalities with 2000+ population that is wholly or partially subject to the requirements above.
  • (I) City and county or county with 10,000+ population and a population increase of either (a) 10%+ from 1994 to 1999, or (b) 10%+ during any 5-year period ending in 2000 or any subsequent year; AND (II) city and county or county with 100,000+ population; AND (III) the counties of Clear Creek, Gilpin, Morgan, and Pitkin.
  • Municipalities with 2000+ population that is wholly or partially subject to the requirements above.
Florida
  • Municipalities with 50,000+ population.
  • Counties with 75,000+ population.
  • Local governments with >50,000 population.
Massachusetts
  • (I) Towns with 10,000+ population, and (II) towns with a planning board. Does not apply to Boston. Otherwise encouraged.
Nevada
  • Counties with 45,000+ population AND counties of less than 45,000 population if they have a planning commission
  • Cities with 25,000+ population AND cities with less than 25,000 population if they have a planning commission
  • Counties with 700,000+ population; otherwise encouraged.
  • Counties with 100,000+ population; otherwise encouraged.
Utah
  • (I) Cities of the first (population 100,000+), second (population 65,000–99,999), third (population 30,000–64,999), or fourth (population 10,000–29,999) class; AND (II) cities of the fifth (population 1000–9999) class with 5000+ population, if the city is located within a county of the first (population 1,000,000+), second (population 175,000–999,999), or third (population 40,000–174,999) class; AND (III) metro townships with 5000+ population
Washington
  • (I) Counties that have a planning agency (i.e., a planning commission or a planning department) AND (II) counties (and the cities located therein) with 50,000+ population that have had population increase by >17% in the previous 10 years, AND (III) counties (and the cities located therein) that have had a population increase by >20% in the previous 10 years; otherwise encouraged.
  • Cities located within counties that fulfill the above requirements AND cities in counties that opt-in to Growth Management Area planning.
  • (I) Counties (and the cities located therein) that opt-in to Growth Management Area planning, AND (II) counties (and the cities located therein) with 50,000+ population that have had a population increase by >17% in the previous 10 years, AND (III) counties (and the cities located therein) that have had a population increase by >20% in the previous 10 years.
Mixed Rural/Urban
Delaware
  • Municipalities with 2000+ population.
Minnesota
  • Counties with <300,000 population and a planning commission; otherwise encouraged for counties <300,000.
Nebraska
  • (I) Metropolitan and primary class cities (population 100,001+), AND (II) first and second class cities (population 801–100,000) that have adopted and not amended a zoning ordinance prior to 17 May 1967
  • Primary (population 100,001–299,000) class cities.
  • Primary (population 100,001–299,000), first (population 5001–100,000), and second (population 801–5000) class cities.
  • Metropolitan (population 300,000+), primary (population 100,001–299,000), first (population 5001–100,000), and second (population 801–5000) class cities.
Pennsylvania
  • Counties second through eighth class (counties < 1,500,000 population)
Most Rural
Kentucky
  • Counties with 300,000+ population, a consolidated local government, and a planning unit; otherwise encouraged.
Oklahoma
  • Counties with 500,000+ population and a planning commission.
  • Cities with >200,000 population.
Where there are multiple bullet points for a state, different items had different population-based conditions and/or there were different conditions for counties and municipalities.

References

  1. McDowell, C.P.; Dishman, R.K.; Gordon, B.R.; Herring, M.P. Physical Activity and Anxiety: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. Am. J. Prev. Med. 2019, 57, 545–556. [Google Scholar] [CrossRef] [PubMed]
  2. Engelen, L.; Gale, J.; Chau, J.Y.; Hardy, L.L.; Mackey, M.; Johnson, N.; Shirley, D.; Bauman, A. Who Is at Risk of Chronic Disease? Associations between Risk Profiles of Physical Activity, Sitting and Cardio-Metabolic Disease in Australian Adults. Aust. N. Z. J. Public Health 2017, 41, 178–183. [Google Scholar] [CrossRef] [PubMed]
  3. Lin, C.-H.; Chiang, S.-L.; Yates, P.; Lee, M.-S.; Hung, Y.-J.; Tzeng, W.-C.; Chiang, L.-C. Moderate Physical Activity Level as a Protective Factor against Metabolic Syndrome in Middle-Aged and Older Women. J. Clin. Nurs. 2015, 24, 1234–1245. [Google Scholar] [CrossRef]
  4. CDC BRFSS Prevalence & Trends Data. Available online: https://www.cdc.gov/brfss/brfssprevalence/index.html (accessed on 23 February 2021).
  5. Whitfield, G.P. Trends in Meeting Physical Activity Guidelines among Urban and Rural Dwelling Adults—United States, 2008–2017. MMWR Morb. Mortal Wkly. Rep. 2019, 68, 513–518. [Google Scholar] [CrossRef] [PubMed]
  6. Ha, A.S.; Chan, W.; Ng, J.Y.Y. Relation between Perceived Barrier Profiles, Physical Literacy, Motivation and Physical Activity Behaviors among Parents with a Young Child. Int. J. Environ. Res. Public Health 2020, 17, 4459. [Google Scholar] [CrossRef] [PubMed]
  7. Nolan, J.A.; Lilly, C.L.; Leary, J.M.; Meeteer, W.; Campbell, H.D.; Dino, G.A.; Cotrell, L. Barriers to Parent Support for Physical Activity in Appalachia. J. Phys. Act. Health 2016, 13, 1042–1048. [Google Scholar] [CrossRef]
  8. Spiteri, K.; Broom, D.; Bekhet, A.H.; de Caro, J.X.; Laventure, B.; Grafton, K. Barriers and Motivators of Physical Activity Participation in Middle-Aged and Older Adults—A Systematic Review. J. Aging Phys. Act. 2019, 27, 929–944. [Google Scholar] [CrossRef]
  9. Chriqui, J.F.; Leider, J.; Thrun, E.; Nicholson, L.M.; Slater, S.J. Pedestrian-Oriented Zoning Is Associated with Reduced Income and Poverty Disparities in Adult Active Travel to Work, United States. Prev. Med. 2017, 95, S126–S133. [Google Scholar] [CrossRef]
  10. Smith, M.; Hosking, J.; Woodward, A.; Witten, K.; MacMillan, A.; Field, A.; Baas, P.; Mackie, H. Systematic Literature Review of Built Environment Effects on Physical Activity and Active Transport—An Update and New Findings on Health Equity. Int. J. Behav. Nutr. Phys. Act. 2017, 14, 158. [Google Scholar] [CrossRef]
  11. Sallis, J.F.; Cervero, R.B.; Ascher, W.; Henderson, K.A.; Kraft, M.K.; Kerr, J. An Ecological Approach to Creating Active Living Communities. Annu. Rev. Public Health 2006, 27, 297–322. [Google Scholar] [CrossRef]
  12. Giles-Corti, B.; Vernez-Moudon, A.; Reis, R.; Turrell, G.; Dannenberg, A.L.; Badland, H.; Foster, S.; Lowe, M.; Sallis, J.F.; Stevenson, M.; et al. City Planning and Population Health: A Global Challenge. Lancet 2016, 388, 2912–2924. [Google Scholar] [CrossRef]
  13. de Leeuw, E.; Simos, J. (Eds.) Healthy Cities: The Theory, Policy, and Practice of Value-Based Urban Planning; Springer: New York, NY, USA, 2017; ISBN 978-1-4939-6692-9. [Google Scholar]
  14. World Health Organization. More Active People for a Healthier World: Global Action Plan on Physical Activity 2018-2030; World Health Organization: Geneva, Switzerland, 2018; ISBN 978-92-4-151418-7. [Google Scholar]
  15. World Health Organization Regional Office for Europe. Towards More Physical Activity in Cities: Transforming Public Spaces to Promote Physical Activity—A Key Contributor to Achieving the Sustainable Development Goals in Europe; World Health Organization: Copenhagen, Denmark, 2017. [Google Scholar]
  16. Salvo, D.; Garcia, L.; Reis, R.S.; Stankov, I.; Goel, R.; Schipperijn, J.; Hallal, P.C.; Ding, D.; Pratt, M. Physical Activity Promotion and the United Nations Sustainable Development Goals: Building Synergies to Maximize Impact. J. Phys. Act. Health 2021, 18, 1163–1180. [Google Scholar] [CrossRef] [PubMed]
  17. Choi, J.; Lee, M.; Lee, J.; Kang, D.; Choi, J.-Y. Correlates Associated with Participation in Physical Activity among Adults: A Systematic Review of Reviews and Update. BMC Public Health 2017, 17, 356. [Google Scholar] [CrossRef]
  18. Kärmeniemi, M.; Lankila, T.; Ikäheimo, T.; Koivumaa-Honkanen, H.; Korpelainen, R. The Built Environment as a Determinant of Physical Activity: A Systematic Review of Longitudinal Studies and Natural Experiments. Ann. Behav. Med. 2018, 52, 239–251. [Google Scholar] [CrossRef]
  19. Community Preventative Services Task Force. Physical Activity: Built Environment Approaches Combining Transportation System Interventions with Land Use and Environmental Design; Community Preventative Services Task Force: Atlanta, GA, USA, 2016. [Google Scholar]
  20. Stankov, I.; Garcia, L.M.T.; Mascolli, M.A.; Montes, F.; Meisel, J.D.; Gouveia, N.; Sarmiento, O.L.; Rodriguez, D.A.; Hammond, R.A.; Caiaffa, W.T.; et al. A Systematic Review of Empirical and Simulation Studies Evaluating the Health Impact of Transportation Interventions. Environ. Res. 2020, 186, 109519. [Google Scholar] [CrossRef]
  21. Christian, H.; Giles-Corti, B.; Knuiman, M.; Timperio, A.; Foster, S. The Influence of the Built Environment, Social Environment and Health Behaviors on Body Mass Index. Results from RESIDE. Prev. Med. 2011, 53, 57–60. [Google Scholar] [CrossRef]
  22. Hansen, A.Y.; Umstattd Meyer, M.R.; Lenardson, J.D.; Hartley, D. Built Environments and Active Living in Rural and Remote Areas: A Review of the Literature. Curr. Obes. Rep. 2015, 4, 484–493. [Google Scholar] [CrossRef]
  23. Hennessy, E.; Kraak, V.I.; Hyatt, R.R.; Bloom, J.; Fenton, M.; Wagoner, C.; Economos, C.D. Active Living for Rural Children: Community Perspectives Using Photovoice. Am. J. Prev. Med. 2010, 39, 537–545. [Google Scholar] [CrossRef] [PubMed]
  24. Yousefian, A.; Ziller, E.; Swartz, J.; Hartley, D. Active Living for Rural Youth: Addressing Physical Inactivity in Rural Communities. J. Public Health Manag. Pract. 2009, 15, 223–231. [Google Scholar] [CrossRef]
  25. Seguin, R.; Connor, L.; Nelson, M.; LaCroix, A.; Eldridge, G. Understanding Barriers and Facilitators to Healthy Eating and Active Living in Rural Communities. J. Nutr. Metab. 2014, 2014, 1–8. [Google Scholar] [CrossRef]
  26. Casanave, K.; Gabbert, K.; Tompkins, N.O.; Murphy, E.; Elliott, E.; Zizzi, S. Environmental Factors Affecting Rural Physical Activity Behaviors: Learning from Community Partners. Prog. Community Health Partnersh. 2021, 15, 349–359. [Google Scholar] [CrossRef]
  27. Umstattd Meyer, M.R.; Moore, J.B.; Abildso, C.; Edwards, M.B.; Gamble, A.; Baskin, M.L. Rural Active Living: A Call to Action. J. Public Health Manag. Pract. 2016, 22, E11–E20. [Google Scholar] [CrossRef]
  28. Godschalk, D.R.; Rouse, D.C. Sustaining Places: Best Practices for Comprehensive Plans; American Planning Association: Chicago, IL, USA, 2015. [Google Scholar]
  29. Norton, R.K. Using Content Analysis to Evaluate Local Master Plans and Zoning Codes. Land Use Policy 2008, 25, 432–454. [Google Scholar] [CrossRef]
  30. Lyles, W.; Berke, P.; Smith, G. Local Plan Implementation: Assessing Conformance and Influence of Local Plans in the United States. Environ. Plan. B Plan. Des. 2016, 43, 381–400. [Google Scholar] [CrossRef]
  31. Rudolf, S.C.; Grădinaru, S.R. The Quality and Implementation of Local Plans: An Integrated Evaluation. Environ. Plan. B Urban Anal. City Sci. 2019, 46, 880–896. [Google Scholar] [CrossRef]
  32. Shah, S.; Wong, B. Toolkit to Integrate Health and Equity into Comprehensive Plans; American Planning Association: Chicago, IL, USA, 2020. [Google Scholar]
  33. Ricklin, A.; Klein, W.; Musiol, E. Healthy Planning: An Evaluation of Comprehensive and Sustainability Plans Addressing Public Health; American Planning Association: Chicago, IL, USA, 2012. [Google Scholar]
  34. American Planning Association. Survey of State Land Use and Natural Hazard Laws; American Planning Association: Chicago, IL, USA, 2019; p. 26. [Google Scholar]
  35. Sullivan, E.J.; Bragar, J. Recent Developments in Comprehensive Planning. Urban Lawyer 2014, 46, 685–702. [Google Scholar]
  36. Hodgson, K. Comprehensive Planning for Public Health: Results of the Planning and Community Health Research Center Study; American Planning Association: Chicago, IL, USA, 2011. [Google Scholar]
  37. Peterson, E.L.; Carlson, S.A.; Schmid, T.L.; Brown, D.R. Prevalence of Master Plans Supportive of Active Living in US Municipalities. Prev. Med. 2018, 115, 39–46. [Google Scholar] [CrossRef]
  38. Evenson, K.R.; Aytur, S.A.; Satinsky, S.B.; Kerr, Z.Y.; Rodríguez, D.A. Planning for Pedestrians and Bicyclists: Results from a Statewide Municipal Survey. J. Phys. Act. Health 2011, 8, S275–S284. [Google Scholar] [CrossRef]
  39. Peterson, E.L.; Carlson, S.A.; Schmid, T.L.; Brown, D.R.; Galuska, D.A. Supporting Active Living through Community Plans: The Association of Planning Documents with Design Standards and Features. Am J Health Promot 2019, 33, 191–198. [Google Scholar] [CrossRef]
  40. Aytur, S.A.; Rodriguez, D.A.; Evenson, K.R.; Catellier, D.J.; Rosamond, W.D. The Sociodemographics of Land Use Planning: Relationships to Physical Activity, Accessibility, and Equity. Health Place 2008, 14, 367–385. [Google Scholar] [CrossRef]
  41. Chriqui, J.F.; Nicholson, L.M.; Thrun, E.; Leider, J.; Slater, S.J. More Active Living-Oriented County and Municipal Zoning Is Associated with Increased Adult Leisure Time Physical Activity--United States, 2011. Environ. Behav. 2016, 48, 111–130. [Google Scholar] [CrossRef]
  42. Nicholson, L.M.; Leider, J.; Chriqui, J.F. Exploring the Linkage between Activity-Friendly Zoning, Inactivity, and Cancer Incidence in the United States. Cancer Epidemiol. Biomark. Prev. 2017, 26, 578–586. [Google Scholar] [CrossRef]
  43. Leider, J.; Chriqui, J.F.; Thrun, E. Associations between Active Living-Oriented Zoning and No Adult Leisure-Time Physical Activity in the U.S. Prev. Med. 2017, 95, S120–S125. [Google Scholar] [CrossRef]
  44. Chriqui, J.F.; Leider, J.; Thrun, E.; Nicholson, L.M.; Slater, S. Communities on the Move: Pedestrian-Oriented Zoning as a Facilitator of Adult Active Travel to Work in the United States. Front. Public Health 2016, 4, 71. [Google Scholar] [CrossRef]
  45. Thrun, E.; Leider, J.; Chriqui, J.F. Exploring the Cross-Sectional Association between Transit-Oriented Development Zoning and Active Travel and Transit Usage in the United States, 2010–2014. Front. Public Health 2016, 4, 113. [Google Scholar] [CrossRef] [PubMed]
  46. Meck, S. Model Planning and Zoning Enabling Legislation: A Short History. In Modernizing State Planning Statutes: The Growing Smart Working Paper Series, Volume One; The Growing Smart Working Paper Series; American Planning Association: Chicago, IL, USA, 1996; Volume 1, pp. 1–18. [Google Scholar]
  47. Meck, S. Growing Smart Legislative Guidebook: Model Statutes for Planning and the Management of Change; American Planning Association: Chicago, IL, USA, 2002. [Google Scholar]
  48. American Law Institute. Model Land Development Code; American Law Institute: Washington, DC, USA, 1976. [Google Scholar]
  49. Berke, P.R.; French, S.P. The Influence of State Planning Mandates on Local Plan Quality. J. Plan. Educ. Res. 1994, 13, 237–250. [Google Scholar] [CrossRef]
  50. Berke, P.R.; Roenigk, D.J.; Kaiser, E.; Burby, R. Enhancing Plan Quality: Evaluating the Role of State Planning Mandates for Natural Hazard Mitigation. J. Environ. Plan. Manag. 1996, 39, 79–96. [Google Scholar] [CrossRef]
  51. Meck, S.; Retzlaff, R.; Schwab, J. Regional Approaches to Affordable Housing; American Planning Association: Chicago, IL, USA, 2013; p. 270. [Google Scholar]
  52. Mersky, R.M.; Dunn, D.J.; Nelson, M.A.; Nelson, M.A.; Jacobstein, J.M. Fundamentals of Legal Research, 8th ed.; University Textbook Series; Foundation Press: New York, NY, USA, 2002; ISBN 978-1-58778-064-6. [Google Scholar]
  53. Cohen, M.L. Legal Research in a Nutshell, 6th ed.; West Pub. Co.: St. Paul, MN, USA, 1996; ISBN 978-0-314-09589-3. [Google Scholar]
  54. LexisNexis. Available online: https://www.lexisnexis.com/en-us/gateway.page (accessed on 28 February 2021).
  55. Burris, S.; Hitchcock, L.; Ibrahim, J.; Penn, M.; Ramanathan, T. Policy Surveillance: A Vital Public Health Practice Comes of Age. J. Health Politics Policy Law 2016, 41, 1151–1173. [Google Scholar] [CrossRef] [PubMed]
  56. Maiden, K.M.; Kaplan, M.; Walling, L.A.; Miller, P.P.; Crist, G. A Comprehensive Scoring System to Measure Healthy Community Design in Land Use Plans and Regulations. Prev. Med. 2017, 95, S141–S147. [Google Scholar] [CrossRef]
  57. Charron, L.M.; Joyner, H.R.; LaGro, J.; Gilchrist Walker, J. Research Note: Development of a Comprehensive Plan Scorecard for Healthy, Active Rural Communities. Landsc. Urban Plan. 2019, 190, 103582. [Google Scholar] [CrossRef]
  58. US Census Bureau 2010 Census Urban and Rural Classification and Urban Area Criteria. Available online: https://www.census.gov/geo/reference/ua/urban-rural-2010.html (accessed on 23 July 2018).
  59. McDonald, J.H. Handbook of Biological Statistics, 2nd ed.; Sparky House Publishing: Baltimore, MD, USA, 2009. [Google Scholar]
  60. StataCorp. Stata Statistical Software: Release 16; StataCorp LLC: College Station, TX, USA, 2019. [Google Scholar]
  61. Jerrett, M.; Almanza, E.; Davies, M.; Wolch, J.; Dunton, G.; Spruitj-Metz, D.; Ann Pentz, M. Smart Growth Community Design and Physical Activity in Children. Am. J. Prev. Med. 2013, 45, 386–392. [Google Scholar] [CrossRef] [PubMed]
  62. McCormack, G.R.; Shiell, A. In Search of Causality: A Systematic Review of the Relationship between the Built Environment and Physical Activity among Adults. Int. J. Behav. Nutr. Phys. Act. 2011, 8, 125. [Google Scholar] [CrossRef] [PubMed]
  63. Umstattd Meyer, M.R.; Perry, C.K.; Sumrall, J.C.; Patterson, M.S.; Walsh, S.M.; Clendennen, S.C.; Hooker, S.P.; Evenson, K.R.; Goins, K.V.; Heinrich, K.M.; et al. Physical Activity–Related Policy and Environmental Strategies to Prevent Obesity in Rural Communities: A Systematic Review of the Literature, 2002–2013. Prev. Chronic Dis. 2016, 13, 150406. [Google Scholar] [CrossRef] [PubMed]
  64. Fitzhugh, E.C.; Bassett, D.R.; Evans, M.F. Urban Trails and Physical Activity. Am. J. Prev. Med. 2010, 39, 259–262. [Google Scholar] [CrossRef]
  65. Winig, B.D.; Wooten, H.; Allbee, A. Building in Healthy Infill; ChangeLab Solutions: Oakland, CA, USA, 2014. [Google Scholar]
  66. Forbes, S.; Anderson, A.; Kline, S.; Brundage, V. Putting Transit to Work in Main Street America: How Smaller Cities and Rural Places Are Using Transit and Mobility Investments to Strengthen Their Economies and Communities 2012. Available online: http://www.reconnectingamerica.org/assets/PDFs/201205ruralfinal.pdf (accessed on 1 January 2018).
  67. Smith, A.S.; Trevelyan, E. The Older Population in Rural America: 2012–2016; American Community Survey Reports; U.S. Census Bureau: Washington, DC, USA, 2019; p. 21. [Google Scholar]
  68. Mishkovsky, N.; Dalbey, M.; Bertaina, S.; Read, A.; McGalliard, T. Putting Smart Growth to Work in Rural Communities; International City/County Management Association: Washington, DC, USA, 2010. [Google Scholar]
  69. Park, T.; Eyler, A.A.; Tabak, R.G.; Valko, C.; Brownson, R.C. Opportunities for Promoting Physical Activity in Rural Communities by Understanding the Interests and Values of Community Members. J. Environ. Public Health 2017, 2017, 1–5. [Google Scholar] [CrossRef]
  70. Matthews, K.A.; Croft, J.B.; Liu, Y.; Lu, H.; Kanny, D.; Wheaton, A.G.; Cunningham, T.J.; Khan, L.K.; Caraballo, R.S.; Holt, J.B.; et al. Health-Related Behaviors by Urban-Rural County Classification—United States, 2013. MMWR Surveill Summ. 2017, 66, 1–8. [Google Scholar] [CrossRef]
  71. Barnidge, E.K.; Radvanyi, C.; Duggan, K.; Motton, F.; Wiggs, I.; Baker, E.A.; Brownson, R.C. Understanding and Addressing Barriers to Implementation of Environmental and Policy Interventions to Support Physical Activity and Healthy Eating in Rural Communities: Barriers to Environmental and Policy Interventions. J. Rural Health 2013, 29, 97–105. [Google Scholar] [CrossRef]
  72. Schilling, J.; Keyes, S.D. The Promise of Wisconsin’s 1999 Comprehensive Planning Law: Land-Use Policy Reforms to Support Active Living. J. Health Polit Policy Law 2008, 33, 455–496. [Google Scholar] [CrossRef]
  73. Authority and Scope of General Plans. Cal. Gov. Code § 65302. Available online: https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=GOV&sectionNum=65302 (accessed on 15 February 2021).
  74. Comprehensive Plans—Mandatory elements. Wash. Rev. Code Ann. § 36.70A.070. Available online: https://app.leg.wa.gov/rcw/default.aspx?cite=36.70a.070 (accessed on 15 February 2021).
  75. Presley, D.; Reinstein, T.; Burris, S. Resources for Policy Surveillance: A Report Prepared for the Centers for Disease Control and Prevention Public Health Law Program; Temple University Beasley School of Law: Philadelphia, PA, USA, 2015. [Google Scholar]
  76. Burby, R.J.; Dalton, L.C. Plans Can Matter! The Role of Land Use Plans and State Planning Mandates in Limiting the Development of Hazardous Areas. Public Adm. Rev. 1994, 54, 229–238. [Google Scholar] [CrossRef]
  77. Sallis, J.F.; Spoon, C.; Cavill, N.; Engelberg, J.K.; Gebel, K.; Parker, M.; Thornton, C.M.; Lou, D.; Wilson, A.L.; Cutter, C.L.; et al. Co-Benefits of Designing Communities for Active Living: An Exploration of Literature. Int. J. Behav. Nutr. Phys. Act. 2015, 12, 30. [Google Scholar] [CrossRef]
Figure 1. Map of state-level rurality with presence of population-conditional rules for comprehensive planning and addressing PA-related plan elements or topics.
Figure 1. Map of state-level rurality with presence of population-conditional rules for comprehensive planning and addressing PA-related plan elements or topics.
Ijerph 18 12190 g001
Table 1. Prevalence and percent of states with statutes addressing, mandating, conditionally mandating, and encouraging comprehensive plan items related to physical activity (PA).
Table 1. Prevalence and percent of states with statutes addressing, mandating, conditionally mandating, and encouraging comprehensive plan items related to physical activity (PA).
PA-Related ItemAddressedMandatedConditionally MandatedEncouraged
n%n%n%n%
Transportation
Transportation/Circulation40802550122436
Streets37742244361224
Public transportation23467146121020
Bicycling11226124812
Pedestrian9186122412
Bicycle/Pedestrian714482412
Land Use & Design
Land use4488326436918
Historic preservation2142112224816
Farmland preservation163271400918
Design132651012714
Infill/Reuse8166120024
Mixed use816242448
Smart growth48361200
Parks & Recreation
Parks/Recreation459023465101734
Natural resources377419385101326
Open space30601632510918
Trails1020363648
Other Relevant
Equity 316215306121020
Physical activity24001212
N = 50. Addressed, item is addressed in state statute either as a mandate, conditional mandate, or encouraged; Mandated, item is required to be included in plan; Conditionally mandated, item is required to be included in plan if certain conditions are met; Encouraged, item is discussed in statute, but there is no language indicating it is required to be in the plan. All data are mutually exclusive. Item headings (italics) are for convenience only and do not reflect attributes of comprehensive plan state statutes themselves. See Appendix A for definitions of each element/topic category. Equity is broadly defined here and includes language about housing and neighborhood quality.
Table 2. Prevalence and percent of states with laws addressing comprehensive plan primary elements, subsumed elements, and topics related to PA.
Table 2. Prevalence and percent of states with laws addressing comprehensive plan primary elements, subsumed elements, and topics related to PA.
PA-Related ItemPrimary ElementSubsumed ElementTopic
n%n%n%
Transportation
Transportation/Circulation275414281326
Streets4823461632
Public transportation12204036
Bicycling12112212
Pedestrian0081624
Bicycle/Pedestrian0071400
Land Use & Design
Land use36729181122
Historic preservation9181122612
Design4851048
Farmland preservation36918510
Infill/Reuse1271412
Smart growth123612
Mixed use0061224
Parks & Recreation
Natural resources224420401428
Parks/Recreation112229582040
Open space71418361224
Trails0081624
Other Relevant
Equity 24241122
Physical activity002400
N = 50. Primary element: Item referred to as element, plan, component, section, “objectives, policies, and programs”, or the item is among a list of same-hierarchy items that are referred to as elements, plans, components, sections, “objectives, policies, and programs”. Subsumed element: Included as part of what an element, plan, component, or section shall or may include. Topic: Items that may or must be included but are not primary or subsumed elements. Data are not mutually exclusive. Item headings (italics) are for convenience only and do not reflect attributes of comprehensive plan state statutes themselves. See Appendix A for definitions of each element/topic category. Equity is broadly defined here and includes language about housing and neighborhood quality.
Table 3. Prevalence of states with population-conditional mandates for PA-related items, compared to prevalence of states addressing the item in state statute.
Table 3. Prevalence of states with population-conditional mandates for PA-related items, compared to prevalence of states addressing the item in state statute.
PA-Related Item# of States with Population-Conditional Mandate on Item# of States that Address Item 1% of States that Address Item that Have a Population-Conditional Mandate for Item 2
Transportation
Transportation/Circulation54012.5
Streets53713.5
Public transportation32313.0
Bicycling21118.2
Bicycle/Pedestrian2728.6
Pedestrian090.0
Land Use & Design
Land Use64413.6
Historic preservation32114.3
Mixed use2825.0
Design21315.4
Smart growth1425.0
Farmland preservation0160.0
Infill/Reuse080.0
Parks & Recreation
Parks/Recreation74515.6
Open space63020.0
Natural resources53713.5
Trails21020.0
Other Relevant
Equity 53116.1
Physical activity020.0
1 Column “Overall—n” from Table 1. 2 # of states with population-conditional mandate on item/# of states that address item × 100. Item headings (italics) are for convenience only and do not reflect attributes of comprehensive plan state statutes themselves. See Appendix A for definitions of each element/topic category. Equity is broadly defined here and includes language about housing and neighborhood quality.
Table 4. Prevalence and percent of states with statutes addressing comprehensive plan elements or topics related to PA, by state-level rurality.
Table 4. Prevalence and percent of states with statutes addressing comprehensive plan elements or topics related to PA, by state-level rurality.
State-Level Rurality 1
PA-Related ItemLeast Rural
(n = 16)
Mixed Rural/Urban
(n = 17)
Most Rural
(n = 17)
n%n%n%Fisher’s Exact 2 p-Value
Transportation
Transportation/Circulation16100.01270.61270.60.038
Streets1275.01376.51270.61.000
Public transportation1168.8741.2529.40.074
Bicycling531.3423.5211.80.401
Pedestrian531.3317.715.90.154
Bicycle/Pedestrian425.015.9211.80.269
Land Use & Design
Land use16100.01376.51588.20.145
Historic preservation850.0635.3741.20.721
Farmland preservation743.8529.4423.50.478
Mixed use743.815.900.00.001
Design637.5317.7423.50.436
Infill/Reuse637.515.915.90.023
Smart growth425.000.000.00.008
Parks & Recreation
Parks/Recreation1487.51588.21694.10.860
Natural resources1487.51270.61164.70.363
Open space1275.0741.21164.70.141
Trails531.315.9423.50.170
Other Relevant
Equity 1381.31058.8847.10.144
Physical activity28.000.000.00.098
1 State-level rurality is defined as the percentage of the state population living outside of 2010 U.S. Census Bureau Urban Areas, categorized by tertile. 2 Fisher’s exact tests here test the null hypothesis that the percentage of states that include each item in their comprehensive planning statute do not differ between the three levels of rurality (i.e., that the gray columns do not differ). Fisher’s exact scores bolded for p < 0.10. Item headings (italics) are for convenience only and do not reflect attributes of comprehensive plan state statutes themselves. See Appendix A for definitions of each element/topic category. Equity is broadly defined here and includes language about housing and neighborhood quality.
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Back to TopTop