title: Rural-urban differences in physical activity, physical fitness, and overweight prevalence of children.
abstract: BACKGROUND
  The increasing prevalence of overweight in youth has been well chronicled, but less is known about the unique patterns and risks that may exist in rural and urban environments. A better understanding of possible rural-urban differences in physical activity profiles may facilitate the development of more targeted physical activity interventions.
  
  
  METHODS
  Participants (1,687 boys; 1,729 girls) were recruited from fourth, fifth, and sixth grade classes in schools from urban areas, small cities, and rural areas. Multilevel modeling analysis was used to examine rural-urban differences in physical activity and prevalence of overweight. Physical activity was assessed by self-report and body mass index was calculated from measured height and weight.
  
  
  RESULTS
  Prevalence of overweight was higher among rural children (25%; P<.001) than children from urban areas (19%) and small cities (17%). Urban children were the least active overall (Cohens' d=-0.4), particularly around lunchtime while at school (d=-0.9 to -1.1). Children from small cities reported the highest levels of physical activity.
  
  
  CONCLUSIONS
  The results of this study suggest there are rural-urban differences in children's prevalence of overweight and physical activity even within a fairly homogenous Midwestern state.
authors.affiliation: Des Moines University Master of Public Health Program, Des Moines University-Osteopathic Medical Center, Des Moines, Iowa 50312, USA. rjoens-m@dmu.edu
authors.forename: Roxane R
authors.initials: RR
authors.lastname: Joens-Matre
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Welk
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Calabro
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Russell
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Nicklay
authors.forename: Larry D
authors.initials: LD
authors.lastname: Hensley
mesh_terms: D015992:Body Mass Index; D002648:Child; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D015146:Midwestern United States / Q000453:epidemiology; D050177:Overweight / Q000453:epidemiology*; D010809:Physical Fitness / Q000502:physiology*; D012424:Rural Population; D011795:Surveys and Questionnaires; D014505:Urban Population