title: Obesity is inversely associated with natural amenities and recreation facilities per capita.
abstract: BACKGROUND
  Little is known about the associations between natural amenities, recreation facility density, and obesity, at a national level. Therefore, the purpose of this paper was to examine associations between county-level natural amenities, density of recreation facilities, and obesity prevalence among United States counties.
  
  
  METHODS
  Data were obtained from a compilation of sources within the United States Department of Agriculture Economic Research Service Food Environment Atlas. Independent variables of interest were the natural amenities scale and recreation facilities per capita. The dependent variable was county-level obesity prevalence. Potential covariates included a measure of county-level percent Black residents, percent Hispanic residents, median age, and median household income. All models were stratified by population loss, persistent poverty, and metro status. Multilevel linear regression models were used to examine the association between obesity and natural amenities and recreation facilities, with "state" as a random effects second level variable.
  
  
  RESULTS
  There were statistically significant negative associations between percent obesity and 1) natural amenities and 2) recreation facilities per capita.
  
  
  CONCLUSIONS
  Future research should examine environmental and policy changes to increase recreation facilities and enhance accessible natural amenities to decrease obesity rates.
authors.affiliation: Dept of Public Health, East Carolina University, Greenville, NC.
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Jilcott Pitts
authors.forename: Michael B
authors.initials: MB
authors.lastname: Edwards
authors.forename: Justin B
authors.initials: JB
authors.lastname: Moore
authors.forename: Kindal A
authors.initials: KA
authors.lastname: Shores
authors.forename: Katrina Drowatzky
authors.initials: KD
authors.lastname: DuBose
authors.forename: David
authors.initials: D
authors.lastname: McGranahan
mesh_terms: D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D004779:Environment Design; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D007899:Leisure Activities; D016014:Linear Models; D009111:Local Government; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D015995:Prevalence; D011998:Recreation; D012111:Residence Characteristics; D012424:Rural Population; D012931:Social Environment; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D016885:United States Department of Agriculture / Q000706:statistics & numerical data; D014505:Urban Population