title: What constitutes an obesogenic environment in rural communities?
abstract: OBJECTIVE
  To identify perceived indicators of the physical environment associated with obesity in rural communities.
  
  
  METHODS
  Cross-sectional telephone survey.
  
  
  METHODS
  Thirteen communities in rural Missouri, Tennessee, and Arkansas, 2003.
  
  
  METHODS
  A total of 2510 adults completed the survey and 2210 respondents were included in the analysis (74% female, 93% white, and 27% obese).
  
  
  METHODS
  The 106-item survey measured perceptions of the neighborhood environment (recreational facilities, land use, transportation/safety, aesthetics, and food environment) and health-related behaviors. The primary outcome was obese (body mass index [BMI] > or = 30 kg/mn2) vs. normal weight (BMI = 18.5-24.9 kg/m2).
  
  
  METHODS
  Logistic regression was used to control for age, gender and education.
  
  
  RESULTS
  Several indicators of the perceived neighborhood environment were associated with being obese (adjusted odds ratio [95% confidence interval]), including furthest distance to the nearest recreational facility (1.8 [1.3-2.4]), unpleasant community for physical activity (1.8 [1.3-2.6]), feeling unsafe from crime (2.1 [1.5-2.9]) or traffic (1.7 [1.2-2.3]), and few nonresidential destinations (1.4 [1.0-1.9]). Distance to recreational facilities and crime safety remained significant in the multivariate model, along with dietary-fat intake, sedentary behavior, and moderate/vigorous physical activity.
  
  
  CONCLUSIONS
  This study adds to a growing evidence base of environmental correlates of obesity and makes a unique contribution regarding rural communities. If causality is established, environmental interventions that target obesogenic neighborhood features may reduce the prevalence of obesity on a population level.
authors.affiliation: Department of Community Health, School of Public Health, Saint Louis University, St. Louis, Missouri, USA.
authors.forename: Tegan K
authors.initials: TK
authors.lastname: Boehmer
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Lovegreen
authors.forename: Debra
authors.initials: D
authors.lastname: Haire-Joshu
authors.forename: Ross C
authors.initials: RC
authors.lastname: Brownson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003415:Crime; D003430:Cross-Sectional Studies; D004032:Diet; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D011998:Recreation; D012111:Residence Characteristics; D012307:Risk Factors; D012424:Rural Population; D012737:Sex Factors