The impact of the built environment on health in rural areas has been understudied and virtually nothing is known about the influence of the rural built environment on overweight in adolescents. Our overarching goal for this study is to examine the influence of the built environment on adolescent overweight in the predominantly rural communities of Northern New England. Our multidisciplinary team will use quantitative and qualitative methods to conduct multi-level assessments of risk factors for adolescent overweight. We will accomplish our aims by studying an established cohort of 2567 adolescents and their parents, representing 26 stable and largely rural communities in Vermont and New Hampshire. When adolescents (8-13 years of age) were first surveyed in 2002-2003, the prevalence of overweight by community ranged from 9.7% to 34.1%, indicating substantial variation at the community level. Relevant individual and family characteristics of this cohort will be assessed through three annual telephone surveys, beginning in January 2006. We will use GIS data and on-site mapping, to characterize the built environment of each community. The community level data will include assessments of recreational resources and food (including fast food) availability, as well as standard measures of density, diversity and design. We will use an ethnographic approach to assess and describe the 'culture' surrounding physical activity and food within each of the schools attended by our cohort. The assessment of multi-level data will allow us to investigate how individual and family characteristics interact with the built environment to influence adolescent overweight. Our primary outcome will be adolescent overweight (defined as body mass index (BMI) equal to or greater than the 95th percentile of the sex-specific BMI-for-age growth curves. Intermediate outcomes will include adolescent physical activity levels and dietary intake patterns, including consumption of high fat and high calorie foods. The multi-disciplinary expertise of our investigative group and the availability of a well-established cohort ensure the feasibility, efficiency, and success of the proposed effort. Relevance: Our study includes children and low SES communities, two populations targeted by RFA-04-003 because of their vulnerability. In addition, our study focuses on rural communities, meeting the expressed need for studies of rural populations. Results from this study will help to identify risk factors that could be targeted through specific interventions to prevent adolescent overweight.
