A Multilevel Analysis of Regional and State Disparities in Physical Inactivity and Activity Levels among US Children, 2003

We examined state- and regional disparities in physical activity and inactivity among US children aged 6-17 years before and after adjusting for individual socioeconomic and behavioral characteristics and area deprivation measures. The 2003 National Survey of Children's Health was used to calculate physical activity and inactivity prevalence in 9 geographic regions and in the 50 states and the District of Columbia (DC). Logistic regression was used to estimate relative odds of physical activity and inactivity. Several disparity indices summarized the geographic variance in crude and adjusted prevalence. Physical activity levels varied substantially across geographic areas, with the East Southcentral region having the highest inactivity prevalence (13.2%) and the Pacific region the lowest prevalence (8.9%). Children in Tennessee and Georgia had 2.3 times the odds and those in Oklahoma, DC, Kentucky, Kansas, Indiana, Maryland, New Jersey, Arkansas, and South Carolina (adjusted prevalence >13.0%) had 1.8-2.0 times the odds of being inactive compared to their counterparts in California (adjusted prevalence=8.1%), after adjusting for such individual characteristics as race/ethnicity, gender, language use, household SES, social capital, neighborhood safety, television viewing, sleep behavior, and parental physical activity. Area poverty, income inequality, and violent crime rates were strong predictors and accounted for further 10% of the state variance in the adjusted prevalence of physical inactivity. Although individual and area-level socioeconomic factors are important predictors, substantial geographic disparities in childhood physical activity remain. Health promotion efforts targeting individual risk factors as well as contextual social and environmental factors may reduce geographic disparities in childhood physical activity.