title: Neighborhood commuting environment and obesity in the United States: an urban-rural stratified multilevel analysis.
abstract: OBJECTIVE
  Automobile dependency and longer commuting are associated with current obesity epidemic. We aimed to examine the urban-rural differential effects of neighborhood commuting environment on obesity in the US METHODS: The 1997-2005 National Health Interview Survey (NHIS) were linked to 2000 US Census data to assess the effects of neighborhood commuting environment: census tract-level automobile dependency and commuting time, on individual obesity status.
  
  
  RESULTS
  Higher neighborhood automobile dependency was associated with increased obesity risk in urbanized areas (large central metro (OR 1.11[1.09, 1.12]), large fringe metro (OR 1.17[1.13, 1.22]), medium metro (OR 1.22[1.16, 1.29]), small metro (OR 1.11[1.04, 1.19]), and micropolitan (OR 1.09[1.00, 1.19])), but not in non-core rural areas (OR 1.00[0.92, 1.08]). Longer neighborhood commuting time was associated with increased obesity risk in large central metro (OR 1.09[1.04, 1.13]), and less urbanized areas (small metro (OR 1.08[1.01, 1.16]), micropolitan (OR 1.06[1.01, 1.12]), and non-core rural areas (OR 1.08[1.01, 1.17])), but not in (large fringe metro (OR 1.05[1.00, 1.11]), and medium metro (OR 1.04[0.98, 1.10])).
  
  
  CONCLUSIONS
  The link between commuting environment and obesity differed across the regional urbanization levels. Urban and regional planning policies may improve current commuting environment and better support healthy behaviors and healthy community development.
authors.affiliation: Division of Population Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA. Electronic address: gyx8@cdc.gov.
authors.forename: Xingyou
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Division of Population Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
authors.forename: James B
authors.initials: JB
authors.lastname: Holt
authors.affiliation: Division of Population Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
authors.forename: Hua
authors.initials: H
authors.lastname: Lu
authors.affiliation: Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Onufrak
authors.affiliation: School of Urban Planning and Design, Shenzhen Graduate School, Peking University, Shenzhen, China. Electronic address: yangjw@pkusz.edu.cn.
authors.forename: Jiawen
authors.initials: J
authors.lastname: Yang
authors.affiliation: School of City and Regional Planning, Georgia Institute of Technology, Atlanta, GA, USA.
authors.forename: Steven P
authors.initials: SP
authors.lastname: French
authors.affiliation: Department of Geography, Ohio State University, Columbus, OH, USA.
authors.forename: Daniel Z
authors.initials: DZ
authors.lastname: Sui
mesh_terms: D000328:Adult; D000368:Aged; D001334:Automobile Driving / Q000523:psychology* / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004779:Environment Design; D005260:Female; D006306:Health Surveys; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D009765:Obesity / Q000453:epidemiology*; D012111:Residence Characteristics; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013997:Time Factors; D014186:Transportation / Q000379:methods* / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data*
keywords: Geocoded National Health Interview Survey (NHIS); Neighborhood automobile dependency; Neighborhood commuting time; Obesity; Regional urbanization levels; The United States