Rural regions in the United States are home to approximately 15-20% of the country’s population. These regions are often characterized by low access to medical care and high rates of disease and death. The literature has detailed the heterogeneous nature of rural health disparities, calling for research detailing regional factors that influence individual-level risk factors such as diet and physical activity. The Mississippi Delta population is largely characterized by high obesity rates, poor diet, and low levels of physical activity. This study presents the most detailed observations of the community-level barriers and facilitators to healthy eating and physical activity within Mississippi Delta communities, contextualizing the findings of a survey of 352 individuals across 25 communities to provide implications and direction for future activities aimed at reducing obesity in the Mississippi Delta. This study observed a high prevalence of overweight (22.9%) and obese (62.1%) body mass index classifications. Chi-square analyses revealed significant relationships between body mass index, age, and health conditions. Community food and physical activity environments and rural characteristics were largely implicated as barriers to fruit and vegetable consumption and physical activity. This article will detail the individual and community-level barriers as they were observed among this sample of Mississippi Delta residents. Next steps involve using qualitative research techniques to guide the development of programmatic strategies for reducing obesity through diet and physical activity in these communities and other rural regions in the United States.
Birch, L.L. (1999). Development of food preferences. Annual Review of Nutrition, 19: 41-62. https://doi.org/10.1146/annurev.nutr.19.1.41
Briggs, A.C., Black, A.W., Lucas, F.L., Siewers, A.E., & Fairfield, K.M. (2019). Association between the food and physical activity environment, obesity, and cardiovascular health across Maine counties. BMC Public Health, 19(1). https://doi.org/10.1186/s12889-019-6684-6
Chatterjee, N., Blakely, D. E., & Barton, C. (2005). Perspectives on obesity and barriers to control from workers at a community center serving low-income Hispanic children and families. Journal of Community Health Nursing, 22(1): 23–36. https://doi.org/10.1207/s15327655jchn2201_3
Cohen, S. A., Cook, S. K., Sando, T. A., & Sabik, N. J. (2017). What aspects of rural life contribute to rural-urban health disparities in older adults? Evidence from a national survey. The Journal of Rural Health, 34(3): 293–303. https://doi.org/10.1111/jrh.12287
Cohen, S. A., Greaney, M. L., & Sabik, N. J. (2018). Assessment of dietary patterns, physical activity and obesity from a national survey: Rural-urban health disparities in older adults. PLOS ONE, 13(12). https://doi.org/10.1371/journal.pone.0208268
Coleman-Jensen, A., Rabbitt, M.P., Gregory, C.A., & Singh, A. (2021). Household Food Security in the United States in 2020, ERR-298, U.S. Department of Agriculture, Economic Research Service.
Connell, C. L., Thomson, J. L., Huye, H. F., Landry, A. S., Crook, L. S. B., & Yadrick, K. (2015). Mississippi Communities for Healthy Living: Implementing a nutrition intervention effectiveness study in a rural health disparate region. Contemporary Clinical Trials, 42, 196–203. https://doi.org/10.1016/j.cct.2015.04.003
Connell, C. L., Wang, S. C., Crook, L. S., & Yadrick, K. (2019). Barriers to Healthcare Seeking and Provision Among African American Adults in the Rural Mississippi Delta Region: Community and Provider Perspectives. Journal of Community Health, 44(4), 636–645. https://doi.org/10.1007/s10900-019-00620-1
Cosby, A.G., McDoom-Echebiri, M.M., James, W., Khandekar, H., Brown, W., Hanna, H.L. (2019). Growth and persistence of place-based mortality in the United States: the rural mortality penalty. American Journal of Public Health, 109(1): 155-162. https://doi.org/10.2105/AJPH.2018.304787
Craig, C.L., Marshall, A.L., Sjostrom, M., Bauman, A.E., Booth, M.L., Ainsworth, B.E., Pratt, M., Ekelund, U., Yngve, A., Sallis, J.F., & Oja, P. (2003). International physical activity questionnaire: 12-country reliability and validity. Medicine and Science in Sports and Exercise, 35(8): 1381-1395. https://doi.org/10.1249/01.MSS.0000078924.61453.FB
Division of Nutrition, Physical Activity, and Obesity (2020). Overcoming Barriers to Physical Activity. CDC.gov https://cdc.gov/physicalactivity/basics/adding-pa/barriers.html
Dutko, P., Poloeg, M.V., Farrigan, T. (2012). Characteristics and influential factors of food deserts, ERR-140, U.S. Department of Agriculture, Economic Research Service.
Dwyer-Lindgren, L., Bertozzi-Villa, A., Stubbs, R.W., Morozoff, C., Mackenbach, J.P., van Lenthe, F.J., Murray, C.J. (2017). Inequalities in life expectancy among US counties, 1980 to 2014: temporal trends and key drivers. JAMA Internal Medicine, 177(7): 1003-1011. https://doi.org/10.1001/jamainternmed.2017.0918
Frost, S.S., Goins, R.T., Hunter, R.H., Hooker, S.P., Bryant, L.L., Kruger, J., & Pluto, D. (2010). Effects of the built environment on physical activity of adults living in rural settings. American Journal of Health Promotion, 24(4): 267-283. https://doi.org/10.4278/ajhp.08040532
Fulkerson, J.A., Story, M., Neumark-Sztainer, D., & Rydell, S. (2008). Family meals: perceptions of benefits and challenges among parents of 8- to 10-year-ole children. Journal of the American Dietetic Association, 108(4): 706-709.
Fulkerson, J.A., Kubik, M.Y., Rydell, S., Boutelle, K.N., Garwick, A., Story, M., Neumark-Sztainer, D., & Dudovitz, B. (2011). Focus groups with working parents of school-aged children: what’s needed to improve family meals? Journal of Nutrition Education and Behavior, 43(3): 189-193. https://doi.org/10.1016.j.jneb.2010.03.006
Fulkerson, J.A., Friend, S., Horning, M., Flattum, C., Draxten, M., Neumark-Sztainer, D., Gurvich, O., Garwick, A., Story, M., & Kubik, M.Y. (2018). Family home food envirionment and nutrition-related parent and child personal and behavioral outcomes of the HOME Plus study: a randomized controlled trial. Journal of the Academy of Nutrition and Dietetics, 118(2): 240-251. https://doi.org/10.1016/j.jand.2017.04.006
Gray, V. B., Byrd, S. H., Fountain, B. J., Rader, N. E., & Frugé, A. D. (2015). Childhood nutrition in the Mississippi Delta: challenges and opportunities. Health Promotion International. https://doi.org/10.1093/heapro/dav072
Hale, N., Probst, J., Robertson, A. (2015). Area deprivation is higher among rural counties-but not all rural counties are deprived. South Carolina Rural Health Research Center. https://sc.edu/study/colleges_schools/public_health/research/research_centers/sc_rural_health_research_center/documents/1431areadeprivationhigherruralcounties2015.pdf
Health Resources & Services Administration. (2021). Defining Rural Population. HRSA. https://www.hrsa.gov/rural-health/about-us/definition/index.html
Health Resources & Services Administration. (2021). MUA Find. Data.HRSA. https://data.hrsa.gov/tools/shortage-area/mua-find
James, W., Cossman, J., Wolf, J.K. (2018) Persistence of death in the United States: the remarkably different mortality patterns between America’s Heartland and Dixieland. Demographic Research, 39: 897-910. https://doi.org/10.4054/DemRes.2018.39.33
Johnson, A.M., Dooley, E.E., Ganzar, L.A., Jovanovic, C.E., Janda, K.M., & Salvo, D. (2019). Neighborhood food environment and physical activity among U.S. adolescents. American Journal of Preventive Medicine, 57(1): 24-31. https://doi.org/10.1016/j.amepre.2019.01.008
Koehler, K. & Drenowatz, C. (2019). Integrated role of nutrition and physical activity for lifelong health. Nutrients, 11(7): 1437. https://doi.org/10.3390/nu11071437
Long, A. S., Hanlon, A. L., & Pellegrin, K. L. (2018). Socioeconomic variables explain rural disparities in US mortality rates: Implications for rural health research and policy. SSM - Population Health, 6: 72–74. https://doi.org/10.1016/j.ssmph.2018.08.009
Mann, G., Cafer, A., Kaiser, K., & Gordon, K. (2020). Community resilience in a rural food system: documenting pathways to nutrition solutions. Public Health, 186, 157–163. https://doi.org/10.1016/j.puhe.2020.06.041
Meit, M., Knudson, A., Gilbert, T., Yu, A.T-C., Tanenbaum, E., Ormson, E., Popat, M. (2014). The 2014 update of the rural-urban chartbook. Rural Health Reform Policy Research Center. https://ruralhealth.und.edu/projects/health-reform-policy-research-center/pdf/2014-rural-urban-chartbook-update.pdf
Mendy, V. L., & Vargas, R. (2015). Trends in major risk factors for cardiovascular disease among adults in the Mississippi Delta region, Mississippi Behavioral Risk Factor Surveillance System, 2001–2010. Preventing Chronic Disease, 12. https://doi.org/10.5888/pcd12.140481
Miller, C.E. & Vasan, R.S. (2021). The southern rural health and mortality penalty: a review of regional health inequities in the United States. Social Science & Medicine, 268. https://doi.org/10.1016/j.socscimed.2020.113443
Mississippi State University Extension. (2021). AIM for CHangE Overview. Extension.MSState. http://extension.msstate.edu/content/aim-for-change-overview
Murray, C.J., Kulkarni, S.C., Michaud, C., Tomijima, N., Buzacchelli, M.T., Iandiorio, T.J., Ezzati, M. (2006). Eight Americas: investigating mortality disparities across races, counties, and race-counties in the United States. PLoS Medicine, 3(9): e260. https://doi.org/10.1371/journal.pmed.0030260
Neumark-Sztainer, D., Maclehose, R., Loth, K., Fulkerson, J.A., Eisenberg, M.E., & Berge, J. (2012). What’s for dinner? Types of food served at family dinner differ across parent and family characteristics. Public Health Nutrition, 17(1): 145-155. https://doi.org/10.1017/S1368980012004594
Oppert, J.M. & Charreire, H. (2012). The importance of the food and physical activity environments. Nestle Nutrition Institute Workshop Series, 73: 113-121. https://doi.org/10.1159/000341306
Patel, S.A., Ali, M.K., Venkat Narayan, K.M., Mehta, N.K. (2016). County-level variation in cardiovascular disease mortality in the United States in 2009-2013: comparative assessment of contributing factors. American Journal of Epidemiology, 184(12): 933-942. https://doi.org/10.1093/aje/kww081
Robinson, J.C., Carson, T.L., Johnson, E.R., Hardy, C.M., Shikany, J.M., Green, E., Willis, L.M., Marron, J.V. Jr., Li, Y., Lee, C.H., & Baskin, M.L. (2014). Assessing environmental support for better health: active living opportunity audits in rural communities in the southern United States. Preventive Medicine, 66: 28-33. https://doi.org/10.1016/j.ypmed.2014.05.021
Roux, A.V.D., Mujahid, M.S., Hirsch, J.A., Moore, K., & Moore, L.V. (2016). The impact of neighborhoods on CV risk. Global Heart, 11(3): 353-363. https://doi.org/10.1016/j.gheart.2016.08.002
Thompson F. E., Subar A. F., Smith A. F., Midthune D., Radimer K. L., Kahle L. L., & Kipnis V. (2002). Fruit and Vegetable Assessment: performance of 2 new, short instruments and a food frequency questionnaire. Journal of the American Dietetic Association, 102(12), 1764–1772. https://doi.org/10.1016/s0002-8223(02)90379-2
Thomson, J.L., Goodman, M.H., & Landry, A.S. (2019). Assessment of town and park characteristics related to physical activity in the lower Mississippi Delta. Preventing Chronic Disease, 16: E35. https://doi.org/10.5888/pcd16.180410
Tussing-Humphreys, L. M., Thomson, J. L., & Onufrak, S. J. (2014). A Church-Based Pilot Study Designed to Improve Dietary Quality for Rural, Lower Mississippi Delta, African American Adults. Journal of Religion and Health, 54(2), 455–469. https://doi.org/10.1007/s10943-014-9823-5
United States Census Bureau. (2019). 2011-2015 American Community Survey 5-year Estimates. https://www.census.gov/programs-surveys/acs/technical-documentation/table-and-geography-changes/2015/5-year.html
U.S. Department of Agriculture & U.S. Department of Health and Human Services. (2020). Dietary Guidelines for Americans, 2020-2025, 9th edition. Washington, D.C.
U.S. Department of Health and Human Services. (2018). Physical Activity Guidelines for Americans, 2nd edition. Washington, D.C.
University of Georgia Extension. (2016). Healthier Together Taliaferro Survey. https://site.extension.uga.edu/healthiertaliaferro/
Wardle, J., Herrera, M., Cooke, L., & Gibson, E. (2003). Modifying children’s food preferences: The effects of exposure and reward on acceptance of an unfamiliar vegetable. European Journal of Clinical Nutrition, 57: 341-348.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright (c) 2022 Katharine Halfacre, PhD, David R. Buys, PhD, Megan E. Holmes, PhD, Erin King, Jacinda Roach, PhD