title: Urban, rural, and regional variations in physical activity.
abstract: OBJECTIVE
  There is some speculation about geographic differences in physical activity (PA) levels. We examined the prevalence of physical inactivity (PIA) and whether U.S. citizens met the recommended levels of PA across the United States. In addition, the association between PIA/PA and degree of urbanization in the 4 main U.S. regions (Northeast, Midwest, South, and West) was determined.
  
  
  METHODS
  Participants were 178,161 respondents to the 2000 Behavioral Risk Factor Surveillance System (BRFSS). Data from 49 states and the District of Columbia were included (excluding Alaska). States were categorized by urban status according to the U.S. Department of Agriculture. Physical activity variables were those commonly used in national surveillance systems (PIA = no leisure-time PA; and PA = meeting a PA recommendation).
  
  
  RESULTS
  Nationally, PA levels were higher in urban areas than in rural areas; correspondingly, PIA levels were higher in rural areas than in urban areas. Regionally, the urban-rural differences were most striking in the South and were, in fact, often absent in other regions. Demographic factors appeared to modify the association.
  
  
  CONCLUSIONS
  The association between PA and degree of urbanization is evident and robust in the South but cannot be generalized to all regions of the United States. For the most part, the Midwest and the Northeast do not experience any relationship between PA and urbanization, whereas, in the West, the trend appears to be opposite of that observed in the South.
authors.affiliation: Centers for Disease Control and Prevention, Division of Nutrition and Physical Activity, Physical Activity and Health Branch, Atlanta, GA 30341, USA. SJL2@cdc.gov
authors.forename: Sarah Levin
authors.initials: SL
authors.lastname: Martin
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Kirkner
authors.forename: Kelly
authors.initials: K
authors.lastname: Mayo
authors.forename: Charles E
authors.initials: CE
authors.lastname: Matthews
authors.forename: J Larry
authors.initials: JL
authors.lastname: Durstine
authors.forename: James R
authors.initials: JR
authors.lastname: Hebert
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D040343:Behavioral Risk Factor Surveillance System; D005006:Ethnicity / Q000523:psychology; D015444:Exercise / Q000523:psychology*; D005260:Female; D005843:Geography; D015438:Health Behavior / Q000208:ethnology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D012423:Rural Health / Q000706:statistics & numerical data*; D012931:Social Environment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States; D014504:Urban Health / Q000706:statistics & numerical data*