Active living environments mediate rural and non-rural differences in physical activity, active transportation, and screen time among adolescents

Disparities in physical activity-related behaviors among rural and non-rural adolescents are important to consider given the relatively recent concerns surrounding the health of rural populations. Differences in rural and non-rural environments may facilitate or hinder physical activity opportunities. The purpose of this study is to examine differences between non-rural and rural adolescents’ moderate-to-vigorous physical activity (MVPA), screen time, and active transportation, including the mediating role of neighborhood resources. Data came from 1,128 adolescents (207 rural, 18%) aged 12–17 years old and their parents living in the United States in the 2014 Family Life, Activity, Sun, Health, and Eating (FLASHE) study. Counterfactual mediation models were used to compare MVPA and screen time (linear regression) and active transit (log-binomial regression) among rural and non-rural adolescents, adjusting for demographics and health and measuring the mediating influence of neighborhood resources for PA. In adjusted models, rural adolescents engaged in less MVPA at school compared to non-rural adolescents (B = −1.14 min/day, p = 0.031) while no difference was found in MVPA at home or on weekends. Rural adolescents had less screen time (B = −2.1 min/day, p = 0.036) than their non-rural peers and were less likely to report active transit trips than non-rural adolescents (OR = 0.66, p = 0.016). Much of the differences in MVPA (70%) and active transit (54%) were mediated by differences in neighborhood resources. Improving the neighborhood resources in rural areas may encourage adolescents to be more active. This includes providing physical activity resources in rural areas such as sidewalks, bike lanes, greenways, playgrounds, fitness facilities, and parks/green space.