Date of Award

Summer 2023

Document Type

Open Access Dissertation


Health Promotion, Education and Behavior

First Advisor

Andrew T Kaczynski


Rising obesity rates, particularly among children, pose a significant public health concern. Of particular concern is the prevalence of childhood obesity in rural communities, with up to 38% of rural children classified as overweight or obese, compared to 30% of urban children. Rural communities often lack the typical built environment characteristics associated with increased physical activity rates and healthy eating behaviors. Further, research on obesogenic environments within rural areas is limited. This study aimed to address this research gap by examining the association between obesogenic environment features and childhood overweight/obesity rates across the urban-rural continuum.

Simple and multiple linear regression models were employed to investigate the associations between the Childhood Obesogenic Environment Index (COEI), food environment, physical activity environment, and the individual variables within the COEI with childhood overweight/obesity rates. To assess moderation effects, counties were classified along the urban-rural continuum utilizing the Rural-Urban Continuum Codes (RUCC). A backward selection model process was utilized to identify a reduced model consisting of a subset of variables that best explained the association with childhood overweight/obesity rates based on rurality. Subsequently, a new COEI score was derived on a national level, incorporating standardized Beta coefficients to assign weights to the variables based on their contributions to the model. The new COEI score was further analyzed in relation to rurality and regional division, employing an analysis of variance.

The findings of this study revealed significant associations between the COEI, the food environment, the physical activity environment, and childhood overweight/obesity rates. Among the variables within the COEI, eight were significantly associated with overweight/obesity rates. Further, this study revealed that the relationship between the obesogenic environment and childhood overweight/obesity rates was modified by rurality. The study's findings also revealed that the full regression model, incorporating all ten variables, yielded significant results in predicting childhood overweight/obesity rates at both the national level and across the entire urban-rural continuum. Along the urban-rural continuum, full-service restaurants remained significant in all models, while walkability retained its significance in most models. Additionally, the study demonstrated that the newly developed COEI derived from the reduced model exhibited significant associations with childhood overweight/obesity rates. Subsequent analyses of the COEI revealed noteworthy variations based on regional division and rurality.

The study underscores the significance of distinct variances in the influence of obesogenic environmental factors on childhood obesity rates across different levels of rurality. Obesogenic environments have significant impacts on childhood obesity rates, and exposure to such environments contributes to the heightened prevalence of childhood obesity observed in rural communities. Understanding which specific features of obesogenic environments are associated with childhood obesity rates across the urban-rural continuum is critical for the development of effective policies and interventions aimed at reducing childhood obesity rates.


© 2023, Kara Lea Ferguson Davis

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