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ObjectiveTo determine if: (1) differences exist for body mass index (BMI) and moderate-to-vigorous physical activity (MVPA) between rural and urban youth, and (2) perceived and objective measures of environmental supports for physical activity differentially correlate with BMI and MVPA in middle school rural and urban youth.MethodCross-sectional analyses were performed in spring 2012 on data collected from December 2008 until May 2010 for 284 middle school youth from a rural county and an adjacent urbanized area. Multivariable linear models estimated associations between BMI/MVPA and perceived environmental barriers/supports for physical activity and objectively measured neighborhood spatial variables.ResultsMean MVPA was significantly lower for rural youth (15.9 minutes/day) compared to urban youth (19.2 minutes/day). No differences were observed between rural and urban youth for BMI or BMI percentile. Significant differences in both perceived and objective correlates for MVPA and BMI percentile were found in multivariable models between rural and urban youth.ConclusionDifferences observed for correlates of MVPA and BMI across the settings suggest that rurality should be considered when identifying targets for intervention to promote MVPA and prevent adiposity in youth.20122016-02-21T00:00:00ZK01 DP001126/DP/NCCDPHP CDC HHS/United StatesP30 DK092950/DK/NIDDK NIH HHS/United StatesU48 DP000060/DP/NCCDPHP CDC HHS/United States23219761PMC476141