title: Mapping the Prevalence of Physical Inactivity in U.S. States, 1984-2015.
abstract: BACKGROUND
  Physical inactivity is a leading cause of morbidity, disability and premature mortality in the U.S. and worldwide. This study aimed to map the prevalence of physical inactivity across U.S. states over the past three decades, and estimate the over-time adjusted changes in the prevalence of physical inactivity in each state.
  
  
  METHODS
  Individual-level data (N = 6,701,954) were taken from the 1984-2015 Behavioral Risk Factor Surveillance System (BRFSS), an annually repeated cross-sectional survey of state-representative adult population. Prevalence of self-reported leisure-time physical inactivity was estimated by state and survey year, accounting for the BRFSS sampling design. Logistic regressions were performed to estimate the changes in the prevalence of physical inactivity over the study period for each state, adjusting for individual characteristics including sex, age, race/ethnicity, education, marital status, and employment status.
  
  
  RESULTS
  The prevalence of leisure-time physical inactivity varied substantially across states and survey years. In general, the adjusted prevalence of physical inactivity gradually declined over the past three decades in a majority of states. However, a substantial proportion of American adults remain physically inactive. Among the 50 states and District of Columbia, 45 had over a fifth of their adult population without any leisure-time physical activity, and 8 had over 30% without physical activity in 2015. Moreover, the adjusted prevalence of physical inactivity in several states (Arizona, North Carolina, North Dakota, Utah, West Virginia, and Wyoming) remained largely unchanged or even increased (Minnesota and Ohio) over the study period.
  
  
  CONCLUSIONS
  Although the prevalence of physical inactivity declined over the past three decades in a majority of states, the rates remain substantially high and vary considerably across states. Closely monitoring and tracking physical activity level using the state physical activity maps can help guide policy and program development to promote physical activity and reduce the burden of chronic disease.
authors.affiliation: Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America.
authors.forename: Ruopeng
authors.identifier: http://orcid.org/0000-0001-9632-0209
authors.initials: R
authors.lastname: An
authors.affiliation: Feinburg School of Medicine, Northwestern University, Chicago, Illinois, United States of America.
authors.forename: Xiaoling
authors.initials: X
authors.lastname: Xiang
authors.affiliation: Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America.
authors.forename: Yan
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America.
authors.forename: Hai
authors.initials: H
authors.lastname: Yan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D040343:Behavioral Risk Factor Surveillance System; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D005843:Geography; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D007899:Leisure Activities; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012044:Regression Analysis; D057185:Sedentary Behavior; D014481:United States; D055815:Young Adult