Rachel Black, Felicity Hasson, Paul Slater, Esther Beck, Sonja McIlfatrick
Building public engagement and access to palliative care and advance care planning: a qualitative study
BMC palliative care
studies identified geographic variation overweight obesity rates among children higher rates overweight obesity often found among children living rural compared urban areas small number studies explored differences overweight obesity based nuanced gradations along urbanrural continuum purpose present study identify differences overweight obesity based gradations along urbanrural continuum among children 42 californian counties populations less 500 000 observational study conducted using fitnessgram data collected 5th 7th 9th grade students public schools california 20102011 fitnessgram dataset merged 2011 public elementarysecondary school universe survey data national center educational statistics common core data includes urbancentric locale code school consisting four broad classifications city suburb town rural broken three subcategories multivariate analyses using general linear model conducted compare differences body mass index bmi geographic regions schools city suburb town rural well 11 urbancentric locale code subcategories none schools located large cities percentage students overweight andor obese compared grade level gender raceethnicity across geographic regions using multivariate logistic regression models analyses adjusted student age grade gender raceethnicity africanamerican asian hispanic indianalaskan white two races unknown eligibility free reduced price meals clustering students school stratified analysis done variable stratification ie grade gender raceethnicity included among covariates significant differences bmi prevalence overweight obesity found geographic regions tukeys method applied adjust multiple comparisons 5 procedurewise error rate pvalue less 005 used indicate statistical significance students suburban schools significantly lower mean bmi lower prevalence overweight students geographic areas p00001 among 5th 7th grade students prevalence obesity overweight varied urbanrural status p00001 p001 respectively 7th grade students suburbs lower rates obesity towns among 9th grade students prevalence overweight obesity varied urbanrural status p002 among females prevalence overweight obesity varied p0006 p00001 respectively suburbs lower rates cities towns among males prevalence obesity varied p00001 suburbs lower rates among whites differences prevalence overweight obesity urbanrural status p001 p 00001 respectively among hispanics prevalence obesity varied urbanrural status p0001 large suburban areas lowest rates obesity compared subcategories students attending schools suburban especially larger suburban areas appear lower prevalence obesity peers schools geographic areas research needed understand factors associated differences weight status urban suburban town rural areas