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County-Level Disparities in Access to Recreational Resources and Associations with Adult Obesity

Michael B. Edwards, Stephanie B. Jilcott, Myron F. Floyd, Justin B. Moore


The availability of low-cost public recreation resources is central to the promotion of leisure time physical activity and in addressing the U.S. obesity crisis. However, health-promoting recreation resources may not be equitably distributed across sociodemographic groups. Most studies examining disparities in recreation resources have used neighborhoods as the unit of analysis, with few comparing county-level environments. Significant policy and resource management decisions can be addressed through analyses of county-level data. Specifically, county-level comparisons may more accurately reflect accessible recreational resources, especially in rural locations. Surveillances of the extent to which disparities exist in the availability of these resources are essential in identifying population needs from a policy and management perspective. Therefore, the purpose of this study was to examine associations between sociodemographic characteristics and recreation environments in all North Carolina counties. Each county’s composite public recreation environment was calculated as the Public Recreation Index (PRI), which included: per-capita acreage of state and federal outdoor recreation areas; per-capita acreage of local parks and recreation areas; and per-capita recreation operating expenditures. Results indicated that socio-economically disadvantaged rural counties had lower PRI scores, signaling less availability of public recreational resources. We also found the expected inverse association between PRI and obesity, even when controlling for percent Black, SE-disadvantage, and percent rural. This finding was in agreement with previous studies demonstrating inverse associations between PA, obesity, and access to public parks and recreation facilities. Our findings, when taken together within the context of opportunity theory, provided evidence for a potential mechanism by which socio-disadvantaged rural counties experience obesity-related health disparities. The PRI includes various indicators of access to recreation, each of which can be addressed by local, state, and federal policies to make greater provisions for areas lacking such resources. Public recreation has a key role to play in improving health. Thus, parks and recreation departments and public land management agencies need to be actively involved in addressing the obesity problem. States can use county-level indices like the PRI to determine local strengths and deficits to encourage equitable development, distribution and management of resources. The findings of this study strengthen the call to local, state, and federal policy makers to earmark funding for constructing and maintaining


Obesity; public recreation supply; public health; county-level analysis; disparities

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