Environmental influences on children's physical activity and eating habits in a rural Oregon County.

PURPOSE. To identify environmental barriers and facilitators of children's physical activity and healthy eating in a rural county. DESIGN. Community-based participatory research using mixed methods, primarily qualitative. SETTING. A rural Oregon county. SUBJECTS. Ninety-five adults, 6 high school students, and 41 fifth-grade students. MEASURES. In-depth interviews, focus groups, Photovoice, and structured observations using the Physical Activity Resource Assessment, System for Observing Play and Leisure Activity, Community Food Security Assessment Toolkit, and School Food and Beverage Marketing Assessment Tool. ANALYSIS. Qualitative data were coded by investigators; observational data were analyzed using descriptive statistics. The findings were triangulated to produce a composite of environmental barriers and assets. RESULTS. Limited recreational resources, street-related hazards, fear of strangers, inadequate physical education, and denial of recess hindered physical activity, whereas popularity of youth sports and proximity to natural areas promoted physical activity. Limited availability and high cost of healthy food, busy lifestyles, convenience stores near schools, few healthy meal choices at school, children's being permitted to bring snacks to school, candy used as incentives, and teachers' modeling unhealthy eating habits hindered healthy eating, whereas the agricultural setting and popularity of gardening promoted healthy eating. CONCLUSIONS. This study provides data on a neglected area of research, namely environmental determinants of rural childhood obesity, and points to the need for multifaceted and multilevel environmental change interventions.