An Ecological Approach to Exploring Rural Food Access and Active Living for Families With Preschoolers.

Objective: To identify factors using the Ecological Model of Childhood Overweight related to accessing nutritious foods and physical activity opportunities from the perspectives of rural parents of preschoolers.

Methods: A mixed-methods study using a quantitative survey (Active Where?) and qualitative interviews. Analyzed interview themes provided context to the survey results. The setting was Head Start centers, county human service offices, and Women, Infants, and Children Program sites in rural counties in the Midwest. Rural parents (n = 377) of preschoolers took part in the survey in 7 Midwestern states; 15 similar participants were interviewed from 1 of the states. Transcribed interviews were coded. Frequencies and chi-square tests were computed; significance was set at P < .05.

Results: The Active Where? survey and interviews revealed that close proximity to recreation spaces and traffic safety issues influenced physical activity. For food access, close proximity to full service grocery stores did not influence access to healthy foods because respondents traveled to urban communities to purchase healthy foods.

Conclusions And Implications: Public transportation solutions and enhanced neighborhood safety are potential community-wide obesity prevention strategies in rural communities. However, interventions should be tailored to the community's stage of readiness. Strong social networks should be considered an asset for community change in these regions.