Abstract
The built environment contributes to an individual’s health, and rural geographies face unique challenges for healthy eating and active living. The purpose of this descriptive study was to assess the nutrition and physical activity environments in rural communities with high obesity prevalence. One community within each of six high obesity prevalence counties in a rural Midwest state completed the Nutrition Environment Measures Survey for Stores (NEMS-S) and the Rural Active Living Assessment (RALA). Data were collected by trained community members and study staff. All communities had at least one grocery store and five had at least one convenience store. Grocery stores had higher mean total NEMS-S scores than convenience stores (26.6 vs. 6.0, p < 0.001), and higher scores for availability (18.7 vs. 5.3, p < 0.001) and quality (5.4 vs. 0, p < 0.001) of healthful foods (higher scores are preferable). The mean RALA town-wide assessment score across communities was 56.5 + 15.6 out of a possible 100 points. The mean RALA program and policy assessment score was 40.8 + 20.4 out of a possible 100 points. While grocery stores and schools are important for enhancing food and physical environments in rural areas, many opportunities exist for improvements to impact behaviors and address obesity.
Highlights
Obesity is a multifaceted public health issue and adult obesity continues to impact much of the United States (U.S.)
Six counties with an obesity prevalence >40% in a rural Midwest state (South Dakota) were identified as part of the Centers for Disease Control and Prevention (CDC) High Obesity Program (HOP) funding aimed at improving the nutrition and physical activity environment to support healthy behaviors [19]
While many grocery stores had fresh produce of acceptable quality (85.5% for both fruits and vegetables), fresh fruits or vegetables were unavailable in convenience stores
Summary
Obesity is a multifaceted public health issue and adult obesity continues to impact much of the United States (U.S.). Data from the National Health and Nutrition Examination. Survey (NHANES) indicate that age-adjusted obesity prevalence among U.S adults aged years and older is 41.9% [1]. National surveillance data indicate obesity prevalence is significantly higher among rural adults compared to urban adults [2,3]. The built environment is defined as manmade surroundings that include buildings, public resources, land use patterns, the transportation system, and design features [5]. The built environment’s role in physical activity is a priority for key public health divisions within the Centers for Disease Control and Prevention (CDC) [6] and is a major focus for
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