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Associations between Natural Amenities, Physical Activity, and Body Mass Index in 100 North Carolina Counties

Purpose. To examine associations between county-level natural amenities, physical activity (PA), and body mass index (BMI). Design and Setting. Cross-sectional study among 100 North Carolina counties. Measures. We obtained percentage of county residents meeting PA criteria and county-wide means for reported height and weight from the North Carolina Behavioral Risk Factor Surveillance System, combining years 2003, 2005, and 2007. The county natural amenities scale was the independent variable. Potential county-level covariates were percentage rural, percentage black, median age, and median household income (Census 2000). Analysis. We conducted weighted bivariate and linear regression analyses to examine relationships between natural amenities, aggregate PA, and aggregate BMI. Results. BMI and natural amenities were negatively associated (parameter estimate = –.13 (.06), p = .03). When percentage meeting PA criteria was included, the parameter estimate attenuated 15%. Conclusion. There was an inverse relationship between natural amenities and BMI, partially mediated by PA.