title: Associations between neighborhood-level factors related to a healthful lifestyle and dietary intake, physical activity, and support for obesity prevention polices among rural adults.
abstract: We examined cross-sectional associations among neighborhood- and individual-level factors related to a healthful lifestyle and dietary intake, physical activity (PA), and support for obesity prevention polices in rural eastern North Carolina adults. We examined perceived neighborhood barriers to a healthful lifestyle, and associations between neighborhood barriers to healthy eating and PA, participants' support for seven obesity prevention policies, and dependent variables of self-reported dietary and PA behaviors, and measured body mass index (BMI) (n = 366 study participants). We then used participants' residential addresses and Geographic Information Systems (GIS) software to assess neighborhood-level factors related to access to healthy food and PA opportunities. Correlational analyses and adjusted linear regression models were used to examine associations between neighborhood-level factors related to a healthful lifestyle and dietary and PA behaviors, BMI, and obesity prevention policy support. The most commonly reported neighborhood barriers (from a list of 18 potential barriers) perceived by participants included: not enough bicycle lanes and sidewalks, not enough affordable exercise places, too much crime, and no place to buy a quick, healthy meal to go. Higher diet quality was inversely related to perceived and GIS-assessed neighborhood nutrition barriers. There were no significant associations between neighborhood barriers and PA. More perceived neighborhood barriers were positively associated with BMI. Support for obesity prevention policy change was positively associated with perceptions of more neighborhood barriers. Neighborhood factors that promote a healthful lifestyle were associated with higher diet quality and lower BMI. Individuals who perceived more neighborhood-level barriers to healthy eating and PA usually supported policies to address those barriers. Future studies should examine mechanisms to garner such support for health-promoting neighborhood changes.
authors.affiliation: Department of Public Health, East Carolina University, Lakeside Annex 8, 600 Moye Blvd, MS 660, Greenville, NC, 27834, USA, jilcotts@ecu.edu.
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Jilcott Pitts
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Keyserling
authors.forename: Larry F
authors.initials: LF
authors.lastname: Johnston
authors.forename: Tosha W
authors.initials: TW
authors.lastname: Smith
authors.forename: Jared T
authors.initials: JT
authors.lastname: McGuirt
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Evenson
authors.forename: Ann P
authors.initials: AP
authors.lastname: Rafferty
authors.forename: Ziya
authors.initials: Z
authors.lastname: Gizlice
authors.forename: Beverly A
authors.initials: BA
authors.lastname: Garcia
authors.forename: Alice S
authors.initials: AS
authors.lastname: Ammerman
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003415:Crime; D003430:Cross-Sectional Studies; D004032:Diet; D015444:Exercise; D005260:Female; D005523:Food Supply; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D009765:Obesity / Q000517:prevention & control*; D012111:Residence Characteristics; D012424:Rural Population; D012449:Safety; D057185:Sedentary Behavior; D012959:Socioeconomic Factors
references.citation: J Rural Health. 2013 Spring;29(2):188-97
references.pmid: 23551649
references.citation: J Womens Health (Larchmt). 2006 Jun;15(5):569-83
references.pmid: 16796484
references.citation: J Rural Health. 2013 Winter;29(1):97-105
references.pmid: 23289660
references.citation: Prev Med. 2006 Jun;42(6):455-9
references.pmid: 16574208
references.citation: Am J Prev Med. 2009 Jan;36(1):74-81
references.pmid: 18977112
references.citation: J Am Diet Assoc. 1991 Nov;91(11):1385-90
references.pmid: 1939975
references.citation: Fam Community Health. 2013 Apr-Jun;36(2):135-46
references.pmid: 23455684
references.citation: J Rural Health. 2012 Fall;28(4):392-7
references.pmid: 23083085
references.citation: J Public Health Manag Pract. 2013 May-Jun;19(3 Suppl 1):S97-S104
references.pmid: 23399933
references.citation: Obes Rev. 2010 Feb;11(2):109-17
references.pmid: 19493302
references.citation: N Engl J Med. 2012 Aug 16;367(7):680-1
references.pmid: 22823559
references.citation: J Sci Med Sport. 2015 Jan;18(1):37-42
references.pmid: 24462117
references.citation: Med Sci Sports Exerc. 2009 Mar;41(3):670-4
references.pmid: 19204582
references.citation: BMC Geriatr. 2010 Jun 02;10:32
references.pmid: 20525208
references.citation: Prev Chronic Dis. 2007 Jan;4(1):A04
references.pmid: 17173712
references.citation: J Am Diet Assoc. 2007 Nov;107(11):1916-23
references.pmid: 17964311
references.citation: J Public Health Manag Pract. 2013 Mar-Apr;19(2):E1-8
references.pmid: 23358301
references.citation: Public Health Nutr. 2013 Nov;16(11):1944-52
references.pmid: 23701901
references.citation: Epidemiology. 1993 Sep;4(5):455-63
references.pmid: 8399695
references.citation: Health Place. 2014 May;27:162-70
references.pmid: 24607875
references.citation: J Public Health Manag Pract. 2013 Nov-Dec;19(6):503-10
references.pmid: 23446877
references.citation: Health Aff (Millwood). 2010 Jan-Feb;29(1):219; aurthor reply 219
references.pmid: 20063451
references.citation: Am J Prev Med. 2000 May;18(4):284-8
references.pmid: 10788730
references.citation: Obes Rev. 2007 Mar;8(2):129-54
references.pmid: 17300279
references.citation: Health Educ Res. 2010 Apr;25(2):355-67
references.pmid: 20167607
references.citation: Soc Sci Med. 2012 Oct;75(7):1254-62
references.pmid: 22727742
references.citation: J Public Health Policy. 2009;30 Suppl 1:S161-76
references.pmid: 19190572
references.citation: J Am Diet Assoc. 2007 Feb;107(2):246-55
references.pmid: 17258961
references.citation: Obes Rev. 2011 May;12(5):e95-e106
references.pmid: 20604870
references.citation: MMWR Recomm Rep. 2009 Jul 24;58(RR-7):1-26
references.pmid: 19629029