Residency and racial/ethnic differences in weight status and lifestyle behaviors among US youth.

Obesity is a serious public health problem facing the youth of America, with rates having more than tripled in the past 30 years among children aged 12 to 17 years old. Obese adolescents are at higher risk in their adult years for obesity and associated health problems, such as cardiovascular disease and diabetes.1,2 While the rise in obesity may be “leveling off” in some countries including the United States, there continue to be historically high rates of obesity and an urgent need to understand its determinants and potential areas for intervention, particularly for some subpopulations at greatest risk.3–5 Both residency and race/ethnicity are potential risk factors for obesity and cardiovascular disease that have been investigated individually, but rarely in conjunction with each other.6–15 However, some reports suggest that rural minorities have the highest rates of reported hypertension and overweight/obesity. Furthermore, nonmetropolitan minorities are the least likely to report meeting the vigorous physical activity recommendations of the Centers for Disease Control and Prevention.16 A finding of compounded risk has been reported for rural blacks who were at greater odds of having diabetes and hypertension than urban or rural whites or urban blacks.17 Though these reports relate to rural minority adults, there is evidence that elevated obesity risk is also reflected in rural minority children and adolescents over and above those found for their urban counterparts. Crude prevalence rates for children 10–17 years of age from the National Survey of Children’s Health (NSCH) 2007 indicated that urban children of non-Hispanic black race were more likely to be obese than urban white youth and that obesity risk differences were even greater for their rural counterparts.18 Thus, it may be that living in rural areas and being a racial/ethnic minority lead to a compounded risk of obesity beyond that of either factor acting alone. It has been stated that rural racial/ethnic minorities constitute a forgotten population and that priority should be given to routine tracking/monitoring data for this population as an important step toward improving the health and welfare of rural America.19 Since adult obesity has its roots in child/adolescent obesity and the triad of conditions (obesity, hypertension, and diabetes) have common roots in poor diet, limited exercise, and sedentary activities, we have chosen to examine the prevalence of obesity and these 3 lifestyle behaviors in metropolitan versus nonmetropolitan (hereafter, referred to as metro and nonmetro) US children and adolescents.1,2,20–22 Effectively addressing racial/ethnic disparities in obesity requires understanding which factors are more prevalent or intensified in racial/ethnic minorities and how environments of minority children might magnify the effects of factors that lead to obesity.23 Therefore, the primary objectives of this study were to: (1) examine the potential concomitant influences of race/ethnicity and place of residency (metro/nonmetro) on the prevalence of youth obesity and (2) determine significant differences in selected behavioral variables such as physical activity, consumption of fatty snack foods, and screen time (ie, electronic media) that may be associated with racial/ethnic and residency differences in youth obesity. It was hypothesized that: (1) nonmetro Hispanic and black youth would evidence greater obesity than metro white youth as well as their metro minority counterparts and (2) racial/ethnic differences in the selected lifestyle behaviors align with differences in obesity across race/ethnicity and metro/nonmetro residency.