Nutrition-related policy and environmental strategies to prevent obesity in rural communities: a systematic review of the literature, 2002-2013.
BACKGROUND
Residents of rural communities in the United States are at higher risk for obesity than their urban and suburban counterparts. Policy and environmental-change strategies supporting healthier dietary intake can prevent obesity and promote health equity. Evidence in support of these strategies is based largely on urban and suburban studies; little is known about use of these strategies in rural communities. The purpose of this review was to synthesize available evidence on the adaptation, implementation, and effectiveness of policy and environmental obesity-prevention strategies in rural settings.


METHODS
The review was guided by a list of Centers for Disease Control and Prevention Recommended Community Strategies and Measurements to Prevent Obesity in the United States, commonly known as the "COCOMO" strategies. We searched PubMed, Cumulative Index of Nursing and Allied Health Literature, Public Affairs Information Service, and Cochrane databases for articles published from 2002 through 2013 that reported findings from research on nutrition-related policy and environmental strategies in rural communities in the United States and Canada. Two researchers independently abstracted data from each article, and resolved discrepancies by consensus.


RESULTS
Of the 663 articles retrieved, 33 met inclusion criteria. The interventions most commonly focused on increasing access to more nutritious foods and beverages or decreasing access to less nutritious options. Rural adaptations included accommodating distance to food sources, tailoring to local food cultures, and building community partnerships.


CONCLUSIONS
Findings from this literature review provide guidance on adapting and implementing policy and environmental strategies in rural communities.
Department of Nutrition, University of North Carolina, Chapel Hill, Gillings School of Global Public Health, CB No 7426, 1700 MLK/Airport Rd, Room 239, Chapel Hill, NC 27599-7426. Telephone: 315-350-1689. Email: lcalancie@unc.edu.
Larissa
L
Calancie
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Jennifer
J
Leeman
East Carolina University, Elizabeth City, North Carolina.
Stephanie B
SB
Jilcott Pitts
Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, Atlanta, Georgia.
Laura Kettel
LK
Khan
National Institutes of Health, Division on Nutrition Research Coordination, Bethesda, Maryland.
Sheila
S
Fleischhacker
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Kelly R
KR
Evenson
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Michelle
M
Schreiner
Montana State University, Billings, Montana; Ellen Barnidge, Saint Louis University, St. Louis, Missouri.
Carmen
C
Byker
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Clint
C
Owens
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Jared
J
McGuirt
Saint Louis University, St. Louis, Missouri.
Ellen
E
Barnidge
US Department of Agriculture Food and Nutrition Service, Washington, DC.
Wesley
W
Dean
University of Washington, Seattle, Washington.
Donna
D
Johnson
University of Vermont, Burlington, Vermont.
Jane
J
Kolodinsky
Tufts University, Boston, Massachusetts.
Emily
E
Piltch
University of Nebraska, Lincoln, Nebraska.
Courtney
C
Pinard
University of Washington, Seattle, Washington.
Emilee
E
Quinn
East Carolina University, Elizabeth City, North Carolina.
Lauren
L
Whetstone
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Alice
A
Ammerman
D001628:Beverages / Q000592:standards*; D002170:Canada; D002487:Centers for Disease Control and Prevention, U.S.; D003153:Community Health Services / Q000379:methods / Q000592:standards; D003159:Community-Institutional Relations; D004779:Environment Design; D005523:Food Supply / Q000592:standards*; D015438:Health Behavior / Q000208:ethnology; D006284:Health Plan Implementation; D006293:Health Promotion / Q000379:methods; D006801:Humans; D018673:Nutrition Policy; D009765:Obesity / Q000517:prevention & control*; D009936:Organizational Innovation; D012111:Residence Characteristics; D012424:Rural Population; D014481:United States