Continued development of the Rural Active Living Perceived Environmental Support Scale (RALPESS): preliminary evidence for validity among American Indians

Abstract

Introduction: The prevalence of childhood cardiovascular disease (CVD) risk factors often increases in more rural geographic regions in the USA. However, research on the topic often has conflicting results. Researchers note differences in definitions of rurality and other factors that would lead to differences in inference, including appropriate use of statistical clustering analysis, representative data, and inclusion of individual-level covariates. The present study's objective was to examine CVD risk factors during childhood by geographic distribution in the US Appalachian region as a first step towards understanding the health disparities in this area. Methods: Rurality and CVD risk factors (including blood pressure, body-mass index (BMI), and cholesterol) were examined in a large, representative sample of fifth-grade students (N=73 014) from an Appalachian state in the USA. A six-category Rural-Urban Continuum Codes classification system was used to define rurality regions. Mixed modeling analysis was used to appropriately cluster individuals within 725 unique zip codes in each of these six regions, and allowed for including several individual-level socioeconomic factors as covariates. Results: Rural areas had better outcomes for certain CVD risk factors (lowest low-density lipoprotein cholesterol (LDL-C), and blood pressure (BP) and highest high-density lipoprotein cholesterol (HDL-C)) whereas mid-sized metro and town areas presented with the worst CVD risk factors (highest BMI% above ideal, mean diastolic BP, LDL-C, total cholesterol, triglyceride levels and lowest HDL-C) outcomes in children and adolescence in this Appalachian state. Conclusions: Counter to the study hypothesis, mid-sized metro areas presented with the worst CVD risk factors outcomes in children and adolescence in the Appalachian state. This data contradicts previous literature suggesting a straightforward link between rurality and cardiovascular risk factors. Future research should include a longitudinal design and explore some of the mechanisms between cardiovascular risk factors and rurality. . Data from National Health and Nutrition Examination Survey (NHANES) shows that, in the USA, 14% of adolescents had elevated BP, 22% had borderline-to-high or high low-density lipoprotein cholesterol (LDL-C), 6% had low high-density lipoprotein cholesterol (HDL-C) (NHANES: 1999(NHANES: -2008 4 and 32% children aged 2-19 years were either overweight or obese (NHANES: 2009(NHANES: -2010 5. Pediatric obesity also increases the likelihood of development of other CVD risk factors during childhood and adolescence 2 . Moreover, research shows that childhood CVD risk factors such as obesity, high BP, and abnormal lipids also track over time into adulthood 6 . Several studies have examined CVD risk factor prevalence and its contributing factors by stratified analysis of various sociodemographic characteristics (such as age, gender, racial/ethnic background and income) 4,5,[7][8][9] ; a select few have examined these differences by urban and rural geog...

Inequities in Physical Activity Environments and Leisure-Time Physical Activity in Rural Communities

“…This finding may have resulted partly from a measurement issue for the home/neighborhood domain. Previous qualitative research in the same region found that much PA around the home occurred through yard work, which would not have been captured in the home/neighborhood measure because of its focus on walkability (25). Notably, perceptions of the various domains were mainly neutral to negative across the board.…”

Hypertension and prehypertension: prevalence and associated factors in Gabonese Youth and Adolescents

“…According to a WHO 2016 report, the prevalence of obesity has increased by nearly 50% in Africa since 2000 [34]. Reducing the risk and the frequency of excess weight must be one of the targets in hypertension prevention and control in children and adolescents [35].…”

“…This association is well known and seems more important in female adolescents and young ladies [10, 18-19, 31, 32, 45] . Waist size, which was not assessed, is also linked to the prehypertension risk, even in the absence of excess weight [31][32][33][34][35][36][37][38][39][40][41][42]. Weight loss is recommended by the NHBP to reduce the risk of hypertension.…”

Hypertension and prehypertension: prevalence and predisposing factors in Gabonese Youth and Adolescents

“…Indeed, according to a WHO 2016 report, the prevalence of obesity has increased by nearly 50% in Africa since 2000 [33]. Reducing the risk and the frequency of excess weight must be one of the targets in hypertension prevention and control in children and adolescents [34].…”

“…This association is well known and seems more important in the girls a,d young women [10, 17-18, 30, 31, 44] . Waist size, which could not be studied in this work, is also linked to the prehypertension risk, even in the absence of excess weight [30][31][32][33][34][35][36][37][38][39][40][41]. Weight loss is recommended by the NHBP to reduce the risk of hypertension.…”