Racial differences between perceptions of environmental and policy factors related to healthy behaviors among rural at-risk residents of eastern North Carolina

Background: Rural US residents are at higher risk of chronic disease compared to urban residents. This disparity may be partly due to limited opportunities for healthy food choices and physical activity in rural environments. Objectives: Among eastern NC residents, examine racial differences between (1) perceptions of neighborhood barriers and supports for a healthy diet and physical activity and (2) personal support for policy changes to facilitate healthier food and physical activity environments. Methods: As part of the Heart Healthy Lenoir (HHL) Project, a community-based, participatory initiative to reduce cardiovascular disease risk, we recruited Lenoir County residents to participate in a lifestyle intervention to reduce CVD risk. In 2010, the population of Lenoir County was 59,495, with 23.2% of residents living in poverty. Participants completed an 18-item questionnaire to assess perceived neighborhood barriers to a healthy diet and physical activity. Participants were also asked to indicate their level of support for seven obesity prevention policy strategies. Examples of policy strategies included “Communities should provide incentives to food stores to locate in rural or low-income areas;” and “Communities should improve sidewalks to support walking.” To better understand disparities in CVD risk and opportunities to decrease them, we present results by self-described race. Results: Of the 339 participants, 215 (63%) were African American, 115 (34%) white, and 8 (2%) other. Compared to whites, African Americans were more likely to report the following as “a big problem” in their neighborhood: (1) too many fast food places (18.6% African American versus 7.8% whites, p = 0.029); (2) too much crime (27.7% versus 13.8%, p = 0.0019); (3) unattended dogs (22.4% versus 9.5%, p = 0.0038); (4) verbal abuse from people on the streets (7.0% versus 1.7%, p = 0.0001); and (5) bad air from cars and factories (18.6% versus 13.8%, p < 0.0001). African Americans indicated higher support for policy change strategies than did whites (p = 0.0026). Conclusions: In this sample, African Americans reported a more challenging built environment in which to consume a healthful diet and be active and expressed greater support for policy changes to improve the environment when compared to whites. To reduce chronic disease risk and risk disparities, identified disparities in the places and spaces where individuals live and work should be addressed.