Subjectively-measured Environmental Support for Physical Activity, Healthy Eating, and Breastfeeding in the Rural United States: A Scoping Review to Inform Opportunities for Public Health Surveillance

Overview

Journal J Healthy Eat Act Living

Date 2025 Mar 10

PMID 40060773

Authors

Marilyn E Wende

M Renee Umstattd Meyer

Kathy J Krey

Randa Lopez Morgan

Bailey Houghtaling

Affiliations

Soon will be listed here.

Abstract

The purpose of this scoping review was to identify subjectively-measured environmental initiatives or factors that influence PA, HE, and/or breastfeeding practices within rural U.S. communities. Guided by a scientific research librarian, searches occurred February through July 2020. Grey literature searches spanned Google, Google Scholar, government pages, and public health, federal nutrition assistance program, Cooperative Extension Services, and related webpages. Four academic databases (Medline, PubMed, Web of Science, Agricola) were selected to identify peer-reviewed research and ProQuest Dissertations and Theses Global were used to identify dissertation research. Inclusion criteria included: (1) breastfeeding, HE, and/or PA focus; (2) environmental factors assessed using subjective measures; (3) specific to U.S. rural populations/contexts; and (4) English language. PA environment results focused on initiatives or factors in recreation (parks, playgrounds, facilities; n=54), street/sidewalk (n=44), or school (n=33) settings. PA environmental initiatives/factors included increasing transport/accessibility or addressing geographic disparities for recreation settings, improving/installing walkability features for streets/sidewalks, integrating PA into lessons, or improving PA equipment/spaces for school settings. HE environment results focused on initiatives in retail (n=65) and schools/childcare (n=33) settings. HE environment change initiatives/factors in retail settings included increasing the availability of fruits/vegetables in existing establishments or the prevalence of healthy food outlets. In schools, HE environmental initiatives/factors increased fruits/vegetables served and/or reduced unhealthy foods. Breastfeeding environment results focused on workplace settings (n=3). Breastfeeding environment initiatives/recommendations in workplaces included increasing compatibility for breastfeeding by addressing environmental and cultural barriers. Results from this scoping review were used to create recommendations to improve PA, HE, or breastfeeding environments in rural U.S. settings.

Citing Articles

Objectively-measured Environmental Support for Physical Activity, Healthy Eating, and Breastfeeding in the Rural United States: A Scoping Review to Inform Opportunities for Public Health Surveillance.

Wende M, Houghtaling B, Krey K, Morgan R, Umstattd Meyer M J Healthy Eat Act Living. 2025; 5(1):1-30.

PMID: 40060772 PMC: 11887923.

References

Martinez-Donate A, Riggall A, Meinen A, Malecki K, Escaron A, Hall B . Evaluation of a pilot healthy eating intervention in restaurants and food stores of a rural community: a randomized community trial. BMC Public Health. 2015; 15:136. PMC: 4331304. DOI: 10.1186/s12889-015-1469-z. View

Jernigan V, Salvatore A, Styne D, Winkleby M . Addressing food insecurity in a Native American reservation using community-based participatory research. Health Educ Res. 2011; 27(4):645-55. PMC: 4719163. DOI: 10.1093/her/cyr089. View

MacKenzie O, George C, Perez-Escamilla R, Lasky-Fink J, Piltch E, Sandman S . Healthy Stores Initiative Associated with Produce Purchasing on Navajo Nation. Curr Dev Nutr. 2020; 3(12):nzz125. PMC: 7053571. DOI: 10.1093/cdn/nzz125. View

Boersma P, Black L, Ward B . Prevalence of Multiple Chronic Conditions Among US Adults, 2018. Prev Chronic Dis. 2020; 17:E106. PMC: 7553211. DOI: 10.5888/pcd17.200130. View

Blumenschine M, Adams M, Bruening M . Prevalence of and Differences in Salad Bar Implementation in Rural Versus Urban Arizona Schools. J Acad Nutr Diet. 2017; 118(3):448-454. DOI: 10.1016/j.jand.2017.09.004. View

Kristjansson A, Elliott E, Bulger S, Jones E, Taliaferro A, Neal W . Needs assessment of school and community physical activity opportunities in rural West Virginia: the McDowell CHOICES planning effort. BMC Public Health. 2015; 15:327. PMC: 4423593. DOI: 10.1186/s12889-015-1702-9. View

Wilcox S, Oberrecht L, Bopp M, Kammermann S, McElmurray C . A qualitative study of exercise in older African American and white women in rural South Carolina: perceptions, barriers, and motivations. J Women Aging. 2005; 17(1-2):37-53. DOI: 10.1300/J074v17n01_04. View

Karpyn A, Riser D, Tracy T, Wang R, Shen Y . The changing landscape of food deserts. UNSCN Nutr. 2020; 44:46-53. PMC: 7299236. View

Shah H, Adler J, Ottoson J, Webb K, Gosliner W . Leaders' Experiences in Planning, Implementing, and Evaluating Complex Public Health Nutrition Interventions. J Nutr Educ Behav. 2019; 51(5):528-538. DOI: 10.1016/j.jneb.2019.02.005. View

10.

Majee W, Jefferson U, Goodman L, Olsberg J . Four Years Later: Rural Mothers' and Employers' Perspectives on Breastfeeding Barriers Following the Passage of the Affordable Care Act. J Health Care Poor Underserved. 2016; 27(3):1110-25. DOI: 10.1353/hpu.2016.0111. View

11.

Wen M, Zhang X, Harris C, Holt J, Croft J . Spatial disparities in the distribution of parks and green spaces in the USA. Ann Behav Med. 2013; 45 Suppl 1:S18-27. PMC: 3590901. DOI: 10.1007/s12160-012-9426-x. View

12.

Friedman D, Freedman D, Choi S, Anadu E, Brandt H, Carvalho N . Provider communication and role modeling related to patients' perceptions and use of a federally qualified health center-based farmers' market. Health Promot Pract. 2013; 15(2):288-97. PMC: 3871943. DOI: 10.1177/1524839913500050. View

13.

Perry C, Saelens B, Thompson B . Intrapersonal, behavioral, and environmental factors associated with meeting recommended physical activity among rural Latino youth. Pediatr Exerc Sci. 2011; 23(4):521-36. PMC: 3677811. DOI: 10.1123/pes.23.4.521. View

14.

Honeycutt S, Leeman J, McCarthy W, Bastani R, Carter-Edwards L, Clark H . Evaluating Policy, Systems, and Environmental Change Interventions: Lessons Learned From CDC's Prevention Research Centers. Prev Chronic Dis. 2015; 12:E174. PMC: 4611860. DOI: 10.5888/pcd12.150281. View

15.

Bopp M, Fallon E, Bolton D, Kaczynski A, Lukwago S, Brooks A . Conducting a Hispanic Health Needs Assessment in rural Kansas: building the foundation for community action. Eval Program Plann. 2012; 35(4):453-60. DOI: 10.1016/j.evalprogplan.2012.02.002. View

16.

Ahmed A, Oshiro C, Loharuka S, Novotny R . Perceptions of middle school educators in Hawai'i about school-based gardening and child health. Hawaii Med J. 2011; 70(7 Suppl 1):11-5. PMC: 3158450. View

17.

Seguin R, Connor L, Nelson M, Lacroix A, Eldridge G . Understanding barriers and facilitators to healthy eating and active living in rural communities. J Nutr Metab. 2015; 2014:146502. PMC: 4276670. DOI: 10.1155/2014/146502. View

18.

Kegler M, Swan D, Alcantara I, Wrensford L, Glanz K . Environmental influences on physical activity in rural adults: the relative contributions of home, church and work settings. J Phys Act Health. 2011; 9(7):996-1003. DOI: 10.1123/jpah.9.7.996. View

19.

Gangeness J . Adaptations to achieve physical activity in rural communities. West J Nurs Res. 2009; 32(3):401-19. DOI: 10.1177/0193945909353767. View

20.

McCormack L, Meendering J . Diet and Physical Activity in Rural vs Urban Children and Adolescents in the United States: A Narrative Review. J Acad Nutr Diet. 2015; 116(3):467-480. DOI: 10.1016/j.jand.2015.10.024. View