2. Demetrius Abshire PhD, RN Abbas Tavakoli DrPH
Ecological Correlates of Obesity and Related Health Behaviors among Adults Living in Rural Areas of South Carolina
Demetrius Abshire PhD, RN
Abbas Tavakoli DrPH

3. What is the biggest barrier to promoting weight loss for people who live in rural areas?

4. “When environmental conditions exercise powerful constraints on behavior, they emerge as the overriding determinants.”
Albert Bandura
Sallis Health Education & Behavior, 45(5),

5. The Social Ecological Model

6. Promoting Healthy Behaviors in Rural Areas
Environmental Constraints1-3
Limited/poor public transportation
Limited options for healthier foods
Physical activity infrastructure lacking
Safety concerns
“Positive Deviants”4
Engaging in healthy behaviors despite constraints
The home environment and motivation are key
Morgan et al BMC Public Health, 16, 305.
Bolin et al J Rural Health, 31(3),
Frost et al Am J Health Promot, 24,
Kegler et al J Primary Prevent, 34, 5-15.

7. The Social Ecological Model in Rural Areas
Healthy Rural Communities 2 (Home & Neighborhood)
Only perceived neighborhood access to healthy food had a direct effect on BMI
Factors positively associated with F/V and fat intake
Household inventory of FVs, family support for FV intake, household inventory of fatty foods
Factors associated with PA
More PA equipment, higher family support, higher self-efficacy
No direct effect between fat and FV intake with BMI
Kegler et al Prev Sci, 15, 1-11

8. Obesity in Rural America
Jackson et al J Rural Health, 21(2);
Trivedi et al RRH, 15; 3267.
Befort et al J Rural Health, 28(4),
Hales et al JAMA, 319(23),
*Large MSA

9. Methods
Cross-sectional survey of rural (n=201) and urban (n=228) dwelling South Carolina adults
Survey Sampling International
Self-reported height and weight
Environmental perceptions for PA, self-efficacy, social support, beliefs regarding diet and exercise
University of Wisconsin Population Health Institute. County Health Rankings & Roadmaps

10. Sample Characteristics
Mean ± SD or n (%)
Gender
Female
Male
Transgender
158 (80)
38 (19)
2 (1)
Ethnicity
Hispanic or Latino
Not Hispanic or Latino
Unknown
6 (3)
175 (90)
14 (7)
Race
Black or African American
White
Multi-racial/Other
51 (26)
125 (63)
22 (11)
Marital Status
Married
Divorced
Single
Other
89 (45)
19 (10)
59 (30)
33 (15)
Education (years)
13.1 ± 3.6
Perceived Financial Status
Not enough to make ends meet
Enough or more than enough
76 (38)
124 (62)
Body mass index (kg/m2)
Underweight
Normal weight
Overweight
Obese
29.3 ± 8.9
11 (6)
61 (31)
45 (23)
78 (40)

11. Results
Hierarchical linear regression for predictors of BMI (coefficients shown for Step 4)
Step
Variable
B (SE)
t-value
p-value R2 1
Intercept
34.79 (5.82)
5.98
<.01
0.04
Education
-0.41 (0.24)
-1.71
0.09
Age
0.11 (0.06)
1.96
0.05
Gender
1.98 (1.90)
1.04
0.30
Black
3.31 (1.74)
1.90
0.06
Multi-racial
3.48 (2.65)
1.31
0.19 2
Self-efficacy (sticking to diet)
-0.18 (0.12)
-1.42
0.16
0.08 3
Seeing others walk or jog
-0.82 (0.63)
-1.30
0.20
0.10 4
Home environment PA supports
-0.33 (0.19)
-1.74
0.12

12. Results
Hierarchical logistic regression for predictors of obesity (ORs shown for Step 4)
Step
Variable OR
95% CI
p-value 1
Education
0.88
0.78 – 0.99
0.04
Age
1.03
1.00 – 1.06
Gender
1.50
0.59 – 3.82
0.39
Black
3.40
1.44 – 8.03
0.01
Multi-racial
1.32
0.37 – 4.71
0.67 2
Self-efficacy (sticking to diet)
0.96
0.91 – 1.02
0.20 3
Seeing others walk or jog
0.82
0.60 – 1.11 4
Home environment PA supports
0.92
0.84 – 1.01
0.09

13. Discussion/Conclusion
Individual, social, and environmental factors correlated with BMI were not predictive of BMI/obesity in multivariable models.
Sociodemographic factors have a significant influence on BMI/obesity.
Next steps: Ecological correlates of behavior
Limitation: Small sample size (interpret findings with caution)

14. Questions, Comments, and Discussion
Thank you!
Questions, Comments, and Discussion
Demetrius Abshire, PhD, RN