U.S. Department of Health and Human Services, Health Resources and Services Administration

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Rural and Urban Children

The health risks facing children often vary by the child’s geographic location. Children living in rural areas are more likely to live in poor families,1 are more vulnerable to death from injuries,2 and are more likely to use tobacco than their counterparts in urban areas.3 Rural families also face particular challenges in gaining access to health care, as they often have to travel greater distances to use health services.4 These discrepancies in health status and health risks are not necessarily attributable to children’s geographic location, but rather are related to the demographic characteristics of the children and families who live in rural areas. Understanding these health risks provides program planners and policymakers important information with which to target services and interventions.

In 2007, more than 81 percent of children lived in urban areas, 9 percent lived in large rural areas, and another 9 percent lived in small or isolated rural areas (data not shown). For the National Survey of Children’s Health, these areas were classified based on zip code, the size of the city or town, and the commuting pattern in the area. Urban areas include metropolitan areas and surrounding towns from which commuters flow into an urban area. Large rural areas include large towns with populations of 10,000 to 49,999 persons and their surrounding areas. Small or isolated rural areas include small towns with populations of 2,500 to 9,999 persons and their surrounding areas.

In 2007, approximately 35 percent of children aged 10–17 years living in small rural areas were overweight or obese, compared to 30.9 percent of children living in urban areas. Children were defined as overweight if their Body Mass Index (BMI), based on parent-reported height and weight, fell between the 85th and 95th percentiles for their age and sex. Those with a BMI at or above the 95th percentile were considered obese. Children living in small rural areas were also more likely to live with a smoker than their urban counterparts (35.0 percent versus 24.4 percent).

1 U.S. Census Bureau, 2008 American Community Survey. Table C17001, accessed through American Factfinder.

2 Cherry DC, Huggins B, Gilmore K. Children’s health in the rural environment. Pediatric Clinics of North America 54 (2007):121-133.

3 Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE. (2009) Monitoring the Future: National Survey Results on Drug Use, 1975-2008. (NIH Publication No. 09-7402.) Bethesda, MD: National Institute on Drug Abuse.

4 Probst JC, Laditka SH, Wang J-Y, Johnson AO. Effects of residence and race on burden of travel for care: cross sectional analysis of the 2001 US National Household Travel Survey. BMC Health Serv Res 2007 Mar 9;7-40.

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