Background
The prevalence of childhood obesity has increased significantly with one in three children being overweight or obese (Flegal, Ogden, Wei, Kuczmarski, & Johnson, 2001; Ogden, Carroll, Kit, & Flegal, 2012; Troiano & Flegal, 1998). According to the Nevada Institute for Children’s Research and Policy (Haboush-Deloye, 2014), nearly 30% of Nevada children entering kindergarten are overweight or obese. Helping families and children develop healthy habits while providing healthy eating and activity supports to balance their energy intake with energy expenditure is an important aspect to maintaining healthy weight, preventing overweight and obesity, and minimizing chronic disease risk. Obesity is even greater among residents in rural areas of the United States (Befort, Nazir, & Perri, 2012) and therefore requires an understanding of the supports and barriers to healthy eating and active living within and among rural communities.

Objectives
The purpose of this mixed methods study is to address supports and barriers that either help or hinder healthy behaviors in rural communities of Nevada.  This session will present the findings from the study, including common supports, barriers, community readiness, recommendations for change and it's relevance to Nevada and other rural communities.

Methods
In a partnership with Oregon State University and 6 other land-grant institutions across the western region, researchers in Nevada engaged rural communities and individuals in Community-Based Participatory Research (CBPR) efforts using a HEAL MAPPS (Healthful Eating Active Living – Mapping Attributes: Participatory Photographic Survey) GPS mapping mechanism to assess features viewed as obesity preventing or promoting. Community resources were surveyed for readiness to implement and support environmentally-based obesity prevention efforts. Four communities in Nevada, Wells (Elko County), Gardnerville-Minden (Douglas County), Caliente (Lincoln County) and Laughlin (Clark County) participated in the project.  Each participating community required the staging of four face-to-face meetings, over a period of two to three months for each site, with most of the quantitative and qualitative data collected simultaneously. These included: 1) an initial stakeholder meeting, 2) a GPS unit training session, 3) a focus group and 4) a community conversation.

Results
Through a mixed methods design, both community features (qualitative) and community readiness (quantitative) results were combined to determine overall supports or barriers that help or hinder obesity prevention in rural Nevada. Qualitative data used for analysis included photos, GPS mapping and journal logs by select community members and as scribed narratives during community conversations.  This data explored resident’s perceptions of design features within their community environment that either promote or prevent obesity.  Environmental necessities for healthy living common to these 4 rural communities included few walkability supports, lack of pedestrian safety, and although many had nice local trails and parks, most were primarily auto-centric.  Recreation centers were also common in all communities but were not affordable and lacked adequate transportation to and from these facilities, particularly for vulnerable populations.  Rural communities also noted poor access to a variety of healthy, affordable fresh fruits and vegetables.

Conclusions
Colorado State University’s Community Readiness Model (Kelly, 2003) was used to gain an understanding of the rural community’s resources and readiness for obesity prevention efforts. The model is comprised of six dimensions that influence a community’s readiness to take action on an issue: community knowledge about the issue, community efforts, community knowledge of the efforts, local leadership, community climate, and local resources related to the issue. The results of the quantitative data, gathered by surveying community members, allow researchers to determine the community’s readiness to change. Community readiness is issue specific and can vary across dimensions and community sectors. Nevada’s stage of readiness to implement environmental and policy strategies to prevent obesity was found to be between Stage 3 (vague awareness) and Stage 4 (pre-planning) based on a scale of 1-9 (Kelly, 2003).  These results combined with an observed lack of engagement from local leaders and school administrators suggest a need to raise awareness among sectors.  Engaging local leaders in an awareness campaign at all levels will help guide appropriate policy implementation.

Implications
Implications from these findings will allow researchers to begin to understand the obesogenic environment of rural Nevadan and other rural communities critical to curbing obesity rates. Based on the communities level of readiness to make change, it can inform policy and aid in improvement of environmental factors that will ultimately lead to an enhanced quality of life for these rural communities.

References

1. Befort, C. A., Nazir, N., & Perri, M. G. (2012). Prevalence of obesity among adults from rural and urban areas of the United States: findings from NHANES (2005-2008). J Rural Health, 28(4), 392-397.
2. Flegal, K. M., Ogden, C. L., Wei, R., Kuczmarski, R. L., & Johnson, C. L. (2001). Prevalence of overweight in US children: comparison of US growth charts from the Centers for Disease Control and Prevention with other reference values for body mass index. [Comparative Study]. The American journal of clinical nutrition, 73(6), 1086-1093.
3. Haboush-Deloye, A. D., D., Phebus, T. (2014). Health Status of Children Entering Kindergarten in Nevada. Nevada Institute for Children’s Research and Policy.
4. Kelly, K. J. e. a. (2003). The Community Readiness Model: A Complementary Approach to Social Marketing Marketing Theory, 3, 411-426.
5. Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2012). Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. [Comparative Study]. JAMA : the journal of the American Medical Association, 307(5), 483-490. doi: 10.1001/jama.2012.40.
6. Troiano, R. P., & Flegal, K. M. (1998). Overweight children and adolescents: description, epidemiology, and demographics. [Review]. Pediatrics, 101(3 Pt 2), 497-504.

Support / Funding Source
Supported in part by USDA/AFRI (Oregon State University)