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The association among rural-urban communities, neighborhood characteristics, and youth physical activity is inconsistent in the literature. We used data from the 2007 National Survey of Children's Health, for youth aged 10-17 years (n = 45,392), to examine the association between physical activity and neighborhood characteristics, after adjusting for known confounders. We also examined the association between physical activity and neighborhood characteristics within seven levels of Rural-Urban Commuting Areas (RUCAs) that depict a continuum from isolated rural to dense urban communities. Attainment of a minimum physical activity level differed by RUCA (P = 0.0004). In adjusted, RUCA-specific models, the presence of parks was associated with attaining a minimum physical activity level in only one of the seven RUCAs (adjusted odds ratio: 3.49; 95 % confidence interval: 1.55, 7.84). This analysis identified no association between youths' minimum physical activity attainment and neighborhood characteristics in unstratified models; and, RUCA-specific models showed little heterogeneity by rural-urban community type. Although this analysis found little association between youth physical activity and neighborhood characteristics, the findings could reflect the crude categorization of the neighborhood amenities (sidewalks, parks, recreation centers) and detracting elements (litter, dilapidated housing, vandalism) and suggests that simple measurement of the presence of an amenity or detracting element is insufficient for determining potential associations with reaching minimum levels of physical activity. By exploring neighborhood characteristics and features of neighborhood amenities within the context of well-defined community types, like RUCAs, we can better understand how and why these factors contribute to different levels of youth physical activity.

Associations Between Neighborhood Characteristics and Physical Activity Among Youth Within Rural–Urban Commuting Areas in the US