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Background  It remains unclear why living outside of an urban environment affects aspects of health, particularly whether these differences can be explained by other factors such as socioeconomic position (SEP). The aim of this study was to compare health risk factors between metropolitan and non-metropolitan young Australian adults and examine whether socioeconomic position (SEP) mediates any differences.    Methods  Cross-sectional data came from an Australia-wide sample of 26–36 year-olds (n = 2567). Information on demographic characteristics, smoking, alcohol consumption, diet, physical activity (PA, mins/week) and mental health were collected by questionnaire, BMI from measured height and weight and daily steps using pedometers. Metropolitan versus non-metropolitan residence was classified from addresses. SEP included individual-level (education, occupation) and area-level measures. Prevalence ratios and ratio of means were calculated using log binomial, log multinomial and linear regression techniques.    Results  Non-metropolitan residents were less likely to meet 2 or more dietary guidelines, reported less leisure-time PA and active commuting but more occupational and domestic PA than metropolitan residents. Non-metropolitan women were more likely to smoke and be obese. No differences in mental health were found. After adjusting for SEP, differences remained significant except for leisure-time PA (men and women) and smoking (women).    Conclusions  Living outside metropolitan areas was associated with more risk factors in these young adults. Individual SEP and area-level disadvantage generally did not explain these differences, suggesting that a focus on geographic location as its own social determinant of health, beyond SEP, is warranted.

A cross-sectional study of geographic differences in health risk factors among young Australian adults: The role of socioeconomic position