title: A cross-sectional study of US rural adults' consumption of fruits and vegetables: do they consume at least five servings daily?
abstract: BACKGROUND
  Rural residents are increasingly identified as being at greater risk for health disparities. These inequities may be related to health behaviors such as adequate fruits and vegetable consumption. There is little national-level population-based research about the prevalence of fruit and vegetable consumption by US rural population adults. The objective of this study was to examine the prevalence differences between US rural and non-rural adults in consuming at least five daily servings of combined fruits and vegetables.
  
  
  METHODS
  Cross-sectional analysis of weighted 2009 Behavioral Risk Factor Surveillance Survey (BRFSS) data using bivariate and multivariate techniques. 52,259,789 US adults were identified as consuming at least five daily servings of fruits and vegetables of which 8,983,840 were identified as living in rural locales.
  
  
  RESULTS
  Bivariate analysis revealed that in comparison to non-rural US adults, rural adults were less likely to consume five or more daily servings of fruits and vegetables (OR=1.161, 95% CI 1.160-1.162). Logistic regression analysis revealed that US rural adults consuming at least five daily servings of fruits and vegetables were more likely to be female, non-Caucasian, married or living with a partner, living in a household without children, living in a household whose annual income was  > $35,000, and getting at least moderate physical activity. They were also more likely to have a BMI of <30, have a personal physician, have had a routine medical exam in the past 12 months, self-defined their health as good to excellent and to have deferred medical care because of cost. When comparing the prevalence differences between rural and non-rural US adults within a state, 37 States had a lower prevalence of rural adults consuming at least five daily servings of fruits and vegetables and 11 States a higher prevalence of the same.
  
  
  CONCLUSIONS
  This enhanced understanding of fruit and vegetable consumption should prove useful to those seeking to lessen the disparity or inequity between rural and non-rural adults. Additionally, those responsible for health-related planning could benefit from the knowledge of how their state ranks in comparison to others vis-à-vis the consumption of fruits and vegetables by rural adults---a population increasingly being identified as one at risk for health disparities.
authors.affiliation: Essentia Institute of Rural Health, Division of Research, 502 East 2nd Street, Duluth, MN, 55805, USA. mlutfiyya@eirh.org
authors.forename: M Nawal
authors.initials: MN
authors.lastname: Lutfiyya
authors.forename: Linda F
authors.initials: LF
authors.lastname: Chang
authors.forename: Martin S
authors.initials: MS
authors.lastname: Lipsky
mesh_terms: D000328:Adult; D000368:Aged; D040343:Behavioral Risk Factor Surveillance System; D015992:Body Mass Index; D002487:Centers for Disease Control and Prevention, U.S.; D003430:Cross-Sectional Studies; D004034:Diet Surveys; D015444:Exercise; D005247:Feeding Behavior / Q000208:ethnology / Q000523:psychology*; D005260:Female; D005638:Fruit; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D017057:Medically Uninsured / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D018673:Nutrition Policy; D010821:Physicians, Family / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data* / Q000639:trends; D012923:Social Class; D011795:Surveys and Questionnaires; D014481:United States; D014675:Vegetables