by Christiaan Abildso, PhD

In the third episode of Views from the Front Porch, my guest is Dr. Jeff Whitfield, epidemiologist with the Physical Activity and Health Branch at the National Center for Chronic Disease Prevention and Health Promotion with the Centers for Disease Control and Prevention. Jeff’s research is guided by personal and professional interests. He grew up Austin, Texas, and was trained in exercise physiology. After his professional start in cardiac rehabilitation, he shifted his focus to population-level factors associated with physical activity while earning his PhD in epidemiology. He has been with the CDC since a 2013 fellowship with the Epidemic Intelligence Service, and loves escaping the Atlanta area for the Blue Ridge Mountains to hike, run the trails, and mountain bike – often in his homemade camper.

A Road Map for a More Active Future

Jeff’s family roots in small-town Texas and professional training have guided multiple recent papers with colleagues, published in MMWR and Preventive Medicine. These have answered the Rural Active Living: A Call to Action paper led by Dr. Renée Umstattd Meyer published by JPHMP in 2016 in multiple ways, providing critical evidence about rural physical activity and the environmental factors associated with walking specifically. Dr. Whitfield and colleagues’ work shows that the prevalence of meeting physical activity guidelines is roughly 22% lower in rural than urban areas of the US, despite gains since 2008. And a follow-up study shows the rural-urban differences in environmental factors associated with leisure and transportation walking. Jeff and I discussed these on a late fall morning, much warmer in Jeff’s hometown of Atlanta than mine in Morgantown.

*Figure from https://www.cdc.gov/mmwr/volumes/68/wr/mm6823a1.htm

Jeff described why the qualities of rural and small towns have a “road map for a more active future” by focusing economic revitalization efforts on improving infrastructure for people to walk in and enjoy thriving main streets and downtowns. Jeff and I focused on multiple calls from the Call to Action paper that he and his colleagues have addressed recently using national data from the 2015 National Health Interview Survey (NHIS) Cancer Control Supplement, the first nationally representative dataset, including ~6,000 rural adults from all 50 states, with perceived environmental walkability measures. Jeff and I discussed the ways in which these analyses help us better recognize the uniqueness among rural places and are starting to build a rural-specific evidence base using ecological models. Jeff and his colleagues found that the differences between urban and rural adults in environmental correlates of walking behavior was noticeable in transportation walking only – not in leisure walking. Purposeful trips, such as for shopping, are more likely accessible in urban areas and thus places to conduct these are associated with transport walking in urban areas only, whereas the social destinations or places for leisure-time activity (eg, a school sports field) that are hubs of activity in rural places – and more accessible than shopping/purposeful destinations – are more strongly associated with transportation walking among rural residents. Revealing the details and/or reasons why will require qualitative, boots-on-the-ground work in rural places.

Jeff described the heavy influence that the “outer rings” of the social ecological model – the policy and community factors – have had on the work of the CDC’s Division of Nutrition, Physical Activity and Obesity within which the Physical Activity and Health Branch resides. As Jeff stated, “These factors may exert small influences on any one individual, but can reach many, if not most, members of a community.” Additional analyses revealed the urban-rural differences in walking barriers and facilitators. For example, loose dogs were a barrier in rural areas but crime was not. Surprisingly, rural residents were more impacted by traffic than rural areas. Why? We discussed hypotheses that rural areas have very limited walking infrastructure and traffic is often higher speed, and thus perceived to be more dangerous, even in the more densely populated rural areas.

Working on the camper.

Enjoying the finished product in the woods.

We talked a bit about the CDC Research Data Center and how to apply to access restricted data (ie, geographic variables), before highlighting the need for physical activity surveillance improvements in rural areas that are limited in national datasets such as the BRFSS due to small sample sizes.

As I reflect on the chat with Jeff, my appreciation grows for the work that he and his CDC colleagues have done to provide national epidemiological evidence about walking and the environmental supports and barriers influencing rural residents. This evidence will continue to grow as we ask more questions of the NHIS data. I am confident that we as a research community can work toward improving surveillance in rural places so that researchers and practitioners know the prevalence of adults and children achieving physical activity guidelines in rural places in addition to the prevalence of inactivity that is readily available.

Listen to the podcast here:

You Might Also Enjoy These Articles in the Journal of Public Health Management and Practice:

• Assessing the Walkability Environments of Churches in a Rural Southeastern County of the United States
• Why Some Walk and Others Don’t: Neighborhood Safety and the Sociodemographic Variation Effect on Walking for Leisure and Transportation
• Practice-Based Evidence Supporting Healthy Eating and Active Living Policy and Environmental Changes

Dr. Christiaan Abildso is an associate professor in the Department of Social and Behavior Sciences in the West Virginia University School of Public Health in Morgantown, WV where he’s lived since 2004 with his wife and two children since. His research interests include health promotion program evaluation and social-ecological determinants of physical activity, including policy and the built environment. Dr. Abildso has multiple peer-reviewed publications about rail-trails, health impact assessment, physical activity planning, and evaluation of state-level health promotion programming. Christiaan is also active in local and state active transportation policy decisions, pedestrian and bicyclist safety, and national research on physical activity in rural areas. When not in the office, you’ll usually find him riding his bike (very safely) on the beautiful trails and country roads of West Virginia.

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