Abstract
BackgroundInsufficient physical activity (PA) is a common health risk and more prevalent in rural populations. Few studies have assessed relationships between the built environment and PA in rural settings, and community policy guidance to promote PA through built environment interventions is primarily based on evidence from urban studies.MethodsParticipants in the Bogalusa Heart Study, a longitudinal study in rural Louisiana, with International Physical Activity Questionnaire data from 2012 to 2013 and a valid residential address (N = 1245) were included. PA was summarized as the number of weekly metabolic equivalent (MET)-minutes of total, transportation, and leisure time PA. The Rural Active Living Assessment street segment audit tool and Google Street View were used to assess features of the built environment overall and in six categories (path features, pedestrian safety features, aesthetics, physical security, destinations and land use) that influence PA. Scores for street segment built environment (overall and in categories) were calculated, for segments and buffers of 0.25, 0.50, 1.00 and 1.50 miles. Associations between built environment scores and PA were assessed with generalized estimating equations.ResultsParticipants reported little weekly total, leisure time, and transportation PA (mean 470, 230 and 43 MET-minutes per week, respectively). A 1-point increase in the overall built environment score was associated with 10.30 additional weekly leisure time MET-minutes within a 1.50 mile buffer (p-value 0.05), with a similar magnitude observed for a 1.00-mile buffer. A 1-point increase in the aesthetic score was associated with significantly higher leisure time PA for all geographic units (from 22.21 to 38.75 MET-minutes weekly) when adjusted for individual covariates, but was attenuated and only significant for the segment of the residence after accounting for other neighborhood characteristics.ConclusionsSignificant associations between features of the environment (overall and aesthetic scores) with leisure time PA were observed among adults in this rural population. Built environment interventions in rural settings face additional barriers of lower population density and greater distances for infrastructure projects, and it is important to identify approaches that are both feasible for rural communities and can promote PA.
Highlights
Physical inactivity is a prevalent behavior associated with increased risk of many chronic health conditions and a detriment to public health [1]
Significant associations between features of the environment with leisure time physical activity (PA) were observed among adults in this rural population
Built environment interventions in rural settings face additional barriers of lower population density and greater distances for infrastructure projects, and it is important to identify approaches that are both feasible for rural communities and can promote PA
Summary
Physical inactivity is a prevalent behavior associated with increased risk of many chronic health conditions and a detriment to public health [1]. Rural populations in the United States are recognized as a health disparity population due to the elevated prevalence of disease and early mortality, both of which are substantially higher in rural populations than among the general adult population of the United States population [6]. Behaviors that contribute to elevated health risk, including smoking, being overweight or obese, and failure to meet PA guidelines are all more prevalent among rural populations in the United States [8, 9]. Over 69% of adults 18 years of age or older living in micropolitan and noncore (i.e. non-metropolitan and rural) counties reported not meeting guidelines for aerobic PA, which was significantly higher than in any metropolitan county classification (i.e. counties including small or large urban areas) [9]. Few studies have assessed relationships between the built environment and PA in rural settings, and community policy guidance to promote PA through built environment interventions is primarily based on evidence from urban studies
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