Nutrition-Related Policy and Environmental Strategies to Prevent Obesity in Rural Communities: A Systematic Review of the Literature, 2002–2013

Abstract

IntroductionResidents of rural communities in the United States are at higher risk for obesity than their urban and suburban counterparts. Policy and environmental-change strategies supporting healthier dietary intake can prevent obesity and promote health equity. Evidence in support of these strategies is based largely on urban and suburban studies; little is known about use of these strategies in rural communities. The purpose of this review was to synthesize available evidence on the adaptation, implementation, and effectiveness of policy and environmental obesity-prevention strategies in rural settings.MethodsThe review was guided by a list of Centers for Disease Control and Prevention Recommended Community Strategies and Measurements to Prevent Obesity in the United States, commonly known as the “COCOMO” strategies. We searched PubMed, Cumulative Index of Nursing and Allied Health Literature, Public Affairs Information Service, and Cochrane databases for articles published from 2002 through 2013 that reported findings from research on nutrition-related policy and environmental strategies in rural communities in the United States and Canada. Two researchers independently abstracted data from each article, and resolved discrepancies by consensus.ResultsOf the 663 articles retrieved, 33 met inclusion criteria. The interventions most commonly focused on increasing access to more nutritious foods and beverages or decreasing access to less nutritious options. Rural adaptations included accommodating distance to food sources, tailoring to local food cultures, and building community partnerships.ConclusionsFindings from this literature review provide guidance on adapting and implementing policy and environmental strategies in rural communities.

Association between Dietary Salt Intake and Progression in the Gastric Precancerous Process

“…In this study, the primary outcome—progression in the precancerous process—was relatively common (33%). All models were adjusted for baseline measures identified as potential confounders by directed acyclic graphs [57] and the existing literature showing socioeconomic status [58,59], fruit and vegetable intake [58,60], and age associated with both salt intake and progression in the gastric precancerous process. We also adjusted for gender, a risk factor for gastric cancer, as salt intake may be associated with gender.…”

The Double Disparity Facing Rural Local Health Departments

“…Compared with urban jurisdictions, rural jurisdictions pass fewer public health policies (25,53). When combined with high poverty rates (121), an unhealthy policy environment contributes to higher rates of risky health behaviors and poor health outcomes.…”

Fruit and vegetable desirability is lower in more rural built food environments of Montana, USA using the Produce Desirability (ProDes) Tool

“…These findings are in line with previous studies showing that produce from rural built food environments is of lower quality than in more metropolitan areas (Byker Shanks et al 2015a). The lower ProDes scores for FV desirability in more rural areas may be due to limited infrastructure for food distribution that pose obstacles to maintaining high-quality produce in rural built food environments (Calancie et al 2015; Johnson et al 2015) as FV quality degrades over time. The lower FV desirability in rural areas is especially problematic as adults in rural communities are less likely than adults in non-rural communities to consume the nationally recommended amount of fruits and vegetables per day (Lutifyya et al 2012).…”