Rural-urban differences in perceived social and built environments and associations with physical activity among youth in the United States.

Objective: To examine rural-urban differences in perceived social and built environment characteristics and assess associations with the frequency of meeting physical activity guidelines among United States youth. Methods: We used data from the 2022-2023 National Survey of Children's Health, a nationally representative sample of United States children and adolescents. Weighted cumulative logit models were used to determine associations between parental perceptions of social/built environments and number of days youth met physical activity guidelines, stratified by rural-urban status. Results: The total sample included 55,551 (Representative N=41,792,444, 11.9 ± 3.5 years, 48% female) youth. Positive perceptions of neighborhood support were associated with higher odds of meeting physical activity guidelines (OR:1.43; 95% CI:1.32,1.54) as were perceptions of school safety (OR:1.29; 95% CI:1.08,1.54). Access to neighborhood amenities was associated with higher odds of meeting guidelines (OR:1.18; 95% CI:1.05,1.34). For rural youth, neighborhood support (OR:1.62; 95% CI: 1.34,1.95) and neighborhood amenities (OR:1.26; 95% CI:1.05,1.52) were positively associated with odds of meeting guidelines. For urban youth, neighborhood support (OR:1.40; 95% CI:1.29,1.53) and school safety (OR:1.31; 95% CI:1.07,1.59) were positively associated with odds of meeting guidelines. Conclusions: Perceived social/built environmental factors are associated with youth physical activity, although associations differ by urbanicity.