Geographic Differences in Obesogenic Behaviors and Overweight and Obesity Among Children and Adolescents.

Introduction: Geographic disparities in childhood obesity have been demonstrated, but research examining differences in obesogenic behaviors by rurality is limited. This study examined children's rates of overweight and obesity, food security, and obesogenic behaviors (ie, physical activity, sleep time, and screen time) by rurality and the association between rurality and these 5 outcomes. Methods: We analyzed cross-sectional data on children and adolescents aged 10 to 17 years (N = 35,963) from the 2021-2022 National Survey of Children's Health, a nationally representative sample of children and adolescents. Frequencies, proportions, and unadjusted results were calculated by using descriptive statistics and bivariate analyses. Multivariable logistic regression models were used to study the relationship between rurality and the 5 outcomes. Results: Compared with urban children, rural children had higher odds of being overweight or obese (adjusted odds ratio [AOR] = 1.36; 95% CI, 1.19-1.56), being food insecure (AOR = 1.27; 95% CI, 1.11-1.44), and not meeting the recommended hours of sleep (AOR = 1.23; 95% CI, 1.07-1.40); and they had lower odds of being physically inactive (AOR = 0.79; 95% CI, 0.70-0.90) and having more than 2 hours of screen time on an average day (AOR = 0.85; 95% CI, 0.75-0.96). Conclusion: The findings from this study are instructive for community partners and program developers in creating policies and programs that allow for multitiered interventions to promote positive health behaviors to reduce overweight and obesity among all children and adolescents.