Prevalence of Obesity Among Adults From Rural and Urban Areas of the United States: Findings From NHANES (2005‐2008)

Purpose: Rural residents have higher rates of chronic diseases compared to their urban counterparts, and obesity may be a major contributor to this disparity. This study is the first analysis of obesity prevalence in rural and urban adults using body mass index classification with measured height and weight. In addition, demographic, diet, and physical activity correlates of obesity across rural and urban residence are examined. Methods: Analysis of body mass index (BMI), diet, and physical activity from 7,325 urban and 1,490 rural adults in the 2005‐2008 National Health and Nutrition Examination Survey (NHANES). Findings: The obesity prevalence was 39.6% (SE = 1.5) among rural adults compared to 33.4% (SE = 1.1) among urban adults (P= .006). Prevalence of obesity remained significantly higher among rural compared to urban adults controlling for demographic, diet, and physical activity variables (odds ratio = 1.18, P= .03). Race/ethnicity and percent kcal from fat were significant correlates of obesity among both rural and urban adults. Being married was associated with obesity only among rural residents, whereas older age, less education, and being inactive was associated with obesity only among urban residents. Conclusions: Obesity is markedly higher among adults from rural versus urban areas of the United States, with estimates that are much higher than the rates suggested by studies with self‐reported data. Obesity deserves greater attention in rural America.     

Off‐Road Vehicle Ridership and Associated Helmet Use in Canadian Youth: An Equity Analysis

Purpose: In North America, the use of off‐road vehicles by young people is increasing, as are related injuries and fatalities. We examined the prevalence of off‐road ridership and off‐road helmet use in different subgroups of Canadian youth in order to better understand possible inequities associated with these health risk behaviors. Methods: Data came from Cycle 6 (2009‐2010) of the WHO Health Behavior in School‐Aged Children Study (HBSC). Participants (n = 26,078) were young people from grades 6‐10 in 436 Canadian schools. Students were asked, for a 12‐mo recall period, how frequently they rode off‐road vehicles and how often they wore a helmet while riding. Engagement in off‐road ridership and helmet use were estimated by age group, gender, urban‐rural geographic location, socioeconomic status, and how long participants had lived in Canada. Findings: About half of the sample reported riding off‐road vehicles (12,750; 52%). Among riders, 5,691 (45%) always wore helmets. Riders were more often older students, male and born in Canada. Students in rural areas and small towns were much more likely to ride off‐road vehicles than their urban peers (RR, 95% CI: 1.28 [1.23–1.33]). Helmet use was less common among females, new immigrants, older students, and those in lower socioeconomic groups. There was little reported difference in helmet use by urban‐rural location. Conclusions: Risks associated with the use of off‐road vehicles and with nonhelmet use are not equitably distributed across Canadian youth. Factors characterizing off‐road ridership (notably urban‐rural location) are distinct from factors for helmet use. Preventive interventions should target population subgroups.     

Geographic and Racial Disparities in Breast Cancer–Related Outcomes in Georgia

Objective

To measure the effects of race/ethnicity, area measures of socioeconomic status (SES) and geographic residency status, and health care supply (HCS) characteristics on breast cancer (BC)-related outcomes.

Data Sources/Study Setting

Female patients in Georgia diagnosed with BC in the years 2000–2009.

Study Design

Multilevel regression analysis with adjustment for variables at the county, census tract (CT), and individual level. The county represents the spatial unit of analysis for HCS. SES and geographic residency status were grouped at the CT level.

Principal Findings

Even after controlling for area-level characteristics, racial and ethnic minority women suffered an unequal BC burden. Despite inferior outcomes for disease stage and receipt of treatment, Hispanics had a marginally significant decreased risk of death compared with non-Hispanics. Higher CT poverty was associated with worse BC-related outcomes. Residing in small, isolated rural areas increased the odds of receiving surgery, decreased the odds of receiving radiotherapy, and decreased the risk of death. A higher per-capita availability of BC care physicians was significantly associated with decreased risk of death.

Conclusions

Race/ethnicity and area-level measures of SES, geographic residency status, and HCS contribute to disparities in BC-related outcomes.     

Disparities in Late Stage Diagnosis,Treatment, and Breast Cancer-Related Death by Race,Age, and Rural Residence Among Women in Georgia

The objectives of this study were to examine the outcomes of late stage breast cancer diagnosis, receiving first course treatment, and breast cancer-related death by race, age, and rural/urban residence in Georgia. The authors used cross-sectional and follow-up data (1992–2007) for Atlanta and Rural Georgia cancer registries that are part of the National Cancer Institute's Surveillance, Epidemiology, and End Results Program (N = 23,500 incident breast cancer cases in non-Hispanic whites or non-Hispanic African Americans). Multilevel modeling and Cox proportional hazard models revealed that compared to whites, African American women had significantly increased odds of late stage diagnosis (odds ratio [OR] = 2.08, p = 0.0001) and unknown tumor stage (OR = 1.27, p = 0.0001), decreased odds of receiving radiation (OR = 0.93, p = 0.041) or surgery (OR = 0.50, p = 0.0001), and increased risk of death following breast cancer diagnosis (hazard rate ratio [HR] = 1.50, p = 0.0001). Increased age was significantly associated with the odds of late/unknown stage at diagnosis, worse treatment, and survival. Women residing in rural areas had significantly decreased odds of receiving radiation and surgery with radiation (OR = 0.59, p = 0.0001), and for receiving breast-conserving surgery compared to mastectomy (OR = 0.73, p = 0.005). Factors affecting each level of the breast cancer continuum are distinct and should be examined separately. Efforts are needed to alleviate disparities in breast cancer outcomes in hard-to-reach populations.     

The Relationship Between Rural Status,Individual Characteristics,and Self‐Rated Health in the Behavioral Risk Factor Surveillance System

Purpose: To examine rural status and social factors as predictors of self‐rated health in community‐dwelling adults in the United States. Methods: This study uses multinomial logistic and cumulative logistic models to evaluate the associations of interest in the 2006 US Behavioral Risk Factor Surveillance System, a cross‐sectional survey of 347,709 noninstitutionalized adults. Findings: Self‐rated health was poorer among rural residents, compared to urban residents (OR = 1.77, 95% CI: 1.54, 1.90). However, underlying risk factors such as obesity, low income, and low educational attainment were found to vary by rural status and account for the observed increased risk (OR = 1.03, 95% CI: 0.94, 1.12). There was little evidence of effect modification by rural status, though the association between obesity and self‐rated health was stronger among urban residents (OR = 2.50, 95% CI: 2.38, 2.64) than among rural residents (OR = 2.18, 95% CI: 2.03, 2.34). Conclusions: Our findings suggest that differences in self‐rated health by rural status were attributable to differential distributions of participant characteristics and not due to differential effects of those characteristics.     

Child Nutritional Status by Rural/Urban Residence: A Cross‐National Analysis

Purpose: Rural children in developing countries have poor health outcomes in comparison with urban children. This paper considers 4 questions regarding the rural/urban difference, namely: (1) do individual‐level characteristics account for rural/urban differences in child nutritional status; (2) do community‐level characteristics account for rural/urban differences net of individual‐level characteristics; (3) does type of residence alter the influence of individual characteristics; and (4) does the rural/urban difference vary across national contexts? Method: Analysis is based on Demographic and Health Survey data from 35 developing countries. Multilevel regression is used to examine rural/urban differences in nutritional status net of individual, community and national determinants of health status. Findings: Rural children have a substantially higher risk of poor nutrition. Much of this disadvantage is because of socioeconomic disadvantage, reproductive norms favoring early and more rapid childbearing, and lack of access to modern medicine. Rural residence also structures the nature of the relationships between socioeconomic status, access to medical care, and nutrition. Finally, the rural/urban gap declines as countries develop. Conclusion: Rural/urban differences in child nutritional status are substantial, and some—but not all—of the differences are attributable to socioeconomic status, access to medical care, and reproductive norms.