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Interaction between the environment and animals in urban settings: integrated and participatory planning.

In urban ecosystems, the ecological system has become completely unbalanced; this, in turn, has led to an increase in well-known problems such as air pollution, ground pollution, and water pollution. This imbalance has also led to the growth and spread of pathogens harmful to man, animals, and plants. Urban sustainability indicators, both global and local, also "indicate" the percentage of population, but these refer only to the human population, not the animal population. Cities need good waste, water, and air management, effective traffic planning, and good zoning of businesses, crafts, and services; over and above these activities, cities also need for planning to take into account the existence of pets (dogs, cats, and etc.) and nonpet animals (insects, birds, mice, etc.). Cities tend to be designed around humans and "on a human scale," without taking into account the fact that a huge animal population is living side by side with people. That explains why overcrowding tends to go hand in hand with urbanization; all these populations, including humans, need to adapt to new spaces and often need to drastically change their behavior. This is a fact that must be included when drafting sustainable city plans. The supposed strategy is that of "integrated-participatory" control of the interactions between the environment and animals in the cities. Strategy will focus on the development of integrated approaches and tools for environment and animal management in the context of urban settings. This will require such specific methods as ecological balance sheets and ecoplans for the planning, management, and control of the interrelation among environment, animal, and public health. The objective is to develop a better understanding of urban biodiversity and of urban ecosystem functioning, in order to understand and minimize the negative impacts of human activities on them. The research will focus on assessing and forecasting changes in urban biodiversity, structure, function, and dynamics of urban ecosystems, with relationships among society, economy, biodiversity, and habitats.

Animals↗

The urban heat island in a small city in coastal Portugal.

This project arose from the need to study the phenomenon of the urban heat island, since only by recognising this phenomenon can we moderate it to improve the human and urban environments. Not only big cities develop urban heat islands. This study detected the presence and recorded the characteristics of an urban heat island in the small coastal city of Aveiro, Portugal. The study was developed through the scheduled measurements of air temperature and the analysis of the geographical, meteorological and urban conditions. The form and intensity of Aveiro's heat island are a response to the interaction of three principal factors: the urban morphology (the hottest zones in the city are those with the tallest and the highest density of buildings, without green spaces and with intense generation of heat from traffic, commerce and services); the meteorological conditions (the intensity of the island is at its maximum when the sky is totally clear and there is no wind, and at its minimum in those situations when there is atmospheric instability, such as wind, cloud and precipitation); and the proximity of the coastal lagoon (which borders the city to the west and northwest and moderates seasonal temperatures. The urban heat island influences the comfort and health of its inhabitants, thus urban planning is very important in the moderation and prevention of this phenomenon.

Air Movements↗

Epidemiologic study of diet and coronary risk factors in relation to central obesity and insulin levels in rural and urban populations of north India.

In a population survey of 162 rural and 152 urban subjects aged 26-65 years at Moradabad, the findings are compared with existing data on Indian immigrants to Britain and United States. In comparison with rural subjects, urban subjects had a higher prevalence of coronary artery disease (8.6 vs. 3.0%) and diabetes (7.9 vs 2.5%), higher blood pressures, total and low density lipoprotein cholesterol, triglycerides and postprandial 2-h blood glucose and plasma insulin similar to observations made in UK in immigrants compared to Europeans. Fasting plasma insulin and high density lipoprotein cholesterol levels in urban subjects were comparable with rural subjects. Mean body weights were significantly higher in urban women, but not in men, than in rural subjects. However the body mass index (22.9 +/- 4.2 vs. 21.6 +/- 2.4 kg/m2) and waist-hip girth ratio (0.89 +/- 0.10 vs. 0.86 +/- 0.07) were significantly higher in urban men compared to rural men without such differences in women. Underlying these differences in risk factors, urban subjects had three times better socioeconomic status than rural subjects and were eating higher total and saturated fat, cholesterol and refined carbohydrates and lower total and complex carbohydrates compared to rural men and women. Energy expenditure during routine and spare time physical activity was significantly higher in rural compared to urban subjects. Those patients who had risk factors, showed lesser physical activity and had greater adverse factors in the diet compared to subjects without risk factors. Body mass index and waist-hip girth ratio in patients with risk factors were significantly higher than in subjects without risk factors. The findings suggest that decreased consumption of total and saturated fat and increased physical activity may be useful for prevention of coronary artery disease among urbans as well as in immigrants.

Adult↗

The urban bias in health facilities in Pakistan.

In this paper we examine the urban bias in the health facilities in Pakistan. Although urban areas in Pakistan contain less than 30% of the population, the health facilities are grossly over-represented here. We have argued that the evolution of the health sector has taken place under the broader dynamics of the economy and society in Pakistan. Opting for a capitalist path of growth, with its inherent class contradictions, the health sector has grown in response to the needs of the bourgeois (predominantly urban) classes. The two factors which we feel are responsible for this urban bias are the type of medical education in Pakistan, and the role of the Government. The pattern of medical education is one which is a replica of the developed countries resulting in a demand for the 'latest' and the 'best' in medical care. The result is an urban-biased, hospital-oriented, curative-care model. The Government of Pakistan has also enhanced this urban-bias by investing heavily in urban-centred health facilities, often at the expense of the larger rural population. We have argued that it is the class structure under capitalism which gives rise to an urban bias. Policies are made by the ruling class, and allocations within and outside the health sector are made not on need, but on political expediency and on the ability to pay. To alter this maldistribution of resources, it is the class structure in Pakistan which will have to be attacked.

Curriculum↗

Communication and education about asthma in rural and urban schools.

OBJECTIVE: To assess the quality of communication and education about asthma in Pennsylvania public schools. METHODS: Survey of a stratified random sample of school nurses in rural and urban Pennsylvania public schools (n = 996) concerning communication with school nurses about asthma by physicians and parents, nurses' perceived obstacles to asthma management at school, and utilization of and need for education about asthma. RESULTS: A total of 757 surveys were received (response rate 76%). Thirty-nine percent of school nurses rated their communication with physicians about asthma as either poor or very poor. Urban nurses were significantly more likely to report poor/very poor physician communication (P = .09). Fifty-two percent of the nurses overall (43% rural, 56% urban) also cited lack of communication with parents as an important obstacle to asthma management. Forty-nine percent of school nurses (43% rural, 52% urban) reported attending an asthma education program during the previous year, and 75% (83% rural, 71% urban) expressed interest in additional education. Education about asthma was provided for classroom teachers in 54% of schools (56% rural, 54% urban) and provided for students in 58% of schools (54% rural, 60% urban). CONCLUSIONS: These findings document need for improvement in communication about children's asthma between school nurses and physicians. Although communication appears better in rural relative to urban schools, it is a salient issue in both settings. Study findings also indicate the need for expanded professional education opportunities for school nurses and improved access to appropriate curricular materials for school staff, parents, and students.

Asthma↗

Urbanization and breast cancer incidence in North Carolina, 1995-1999.

PURPOSE: Breast cancer incidence rates are reported to be higher in urban compared with rural areas in the United States. We investigated the relationship between urbanization and breast cancer in North Carolina (1995-1999), and considered hospital characteristics as an explanation. METHODS: We calculated age-adjusted in situ and invasive female breast cancer incidence rates stratified by race, urbanization (Urban Influence Codes), and the presence of a hospital with a cancer registry and cancer program approval in a county. RESULTS: For white women, incidence rate ratios (IRRs) comparing the most urban with the most rural counties were 1.60 for in situ and 1.18 for invasive cancer. For non-white women, IRRs were 1.27 and 0.99, respectively. IRRs for incidence in registry hospital counties versus those without were all > 1.00 and differences were greater for in situ cancer than invasive. For most strata, urban excesses were attenuated when further stratified by registry hospital status. CONCLUSIONS: For most strata, we observed excess incidence in urban counties, but it appeared to be explained through the urban preponderance of registry hospitals. Counties with these hospitals may have higher incidence because of increased detection. Area hospital characteristics should be considered when evaluating geographic patterns of breast cancer incidence.

Adult↗

Rural versus urban inpatient case-mix differences in the US.

BACKGROUND: Preparation of surgeons for practice in rural settings is hindered by limited knowledge of case-mix differences between rural and nonrural surgical practices. Although surgical practice in isolated rural areas is believed to be very different from urban practice, little is known about actual inpatient case-mix differences. STUDY DESIGN: We performed a retrospective, descriptive comparison of inpatient general surgical procedures performed at rural versus urban hospitals in the US using the Nationwide Inpatient Sample database (2000 to 2001). Rural versus urban geographic designations were based on Rural-Urban Commuting Area codes developed by the Rural Health Research Institute. Inpatient surgical procedures were aggregated by the Clinical Classifications Software based on ICD-9-CM procedure codes. RESULTS: Operations on the bowel, appendix, and gallbladder constitute 61% of general surgical inpatient procedures in rural hospitals, compared with 46% in urban hospitals. Compared with urban general surgery practices, rural practices include substantially fewer operations on the stomach and esophagus (6% versus 11%), liver and pancreas (0% versus 1%), spleen and thyroid (3% versus 10%), and bowel (17% versus 19%). General surgical procedures constitute 42% of inpatient procedures in rural hospitals versus 25% in urban hospitals. A rural general surgeon more broadly trained in selected obstetric and gynecologic operations could potentially perform 66% of all inpatient procedures in rural hospitals. Addition of simple vascular cases (eg, arteriovenous fistula, vascular access), head and neck operations, amputations, and nephrectomies could increase this potential to 71% of all cases. CONCLUSIONS: Rural and urban general surgical inpatient case-mixes differ from each other substantially. Additional competence in a few surgical areas that are not currently emphasized in general surgical training could result in an increased role for general surgeons practicing in rural areas.

Diagnosis-Related Groups↗

Differences in risk of mortality under 1 year of age between rural and urban areas: an ecological study.

OBJECTIVE: To investigate differences in risk of categories and causes of death before 1 year of age between rural and urban areas. METHODS: Population-based ecological study using Poisson regression analysis of data from all enumeration districts in Wales. Data included all 243,223 registrable births to women resident in Wales, 809 therapeutic and spontaneous abortions, 1302 stillbirths and 1418 infant deaths occurring between 1993 and 1999. MAIN RESULTS: The relative risk of mortality in rural areas compared with urban areas for all deaths before 1 year of age was 0.89 (95% confidence interval 0.82, 0.98, P=0.02). The risk of mortality in rural areas was significantly lower than in urban areas for all categories of deaths occurring after 7 days of life. The relative risk of death due to infection was significantly lower in rural areas compared with urban areas (P=0.04), with similar results for deaths due to sudden infant death syndrome (P=0.03). After adjusting for social deprivation, there were no significant differences in the risk of death between rural and urban areas. CONCLUSIONS: While there were significant differences in crude risk between rural and urban enumeration districts for some causes and age groups before 1 year, after adjusting for social deprivation, these differences were not significant. The lack of significant interaction between rurality and deprivation indicated that the relationship between social deprivation and death before 1 year of age was not significantly different in rural areas compared with urban areas. Collaborative public health programmes to tackle deprivation are necessary in both rural and urban areas.

Age Distribution↗

Lead concentrations in feathers and blood of common blackbirds (Turdus merula) and in earthworms inhabiting unpolluted and moderately polluted urban areas.

Despite the dramatic decrease of atmospheric lead (Pb) concentrations in urban areas of most industrialised countries, we hypothesised that urban common blackbirds (Turdus merula) may still be contaminated by Pb concentrations of toxicological concern due to transfer from soil through the food chain. We sampled blackbirds and earthworms, one of their main preys, in Besançon, a middle-size city of Eastern France (where atmospheric Pb concentrations decreased from 0.5 microg/m(3) in 1987 to nearly 0 in 2002) and in a rural reference site. Lead concentrations were determined in the tissues of the different functional groups of earthworms (anecic, epigeous and endogeous) and in blood, washed and unwashed outermost tail feathers and breast feathers of blackbirds. Fresh masses and an index of individual body condition were measured in the two blackbird populations as biomarkers of possible toxic effects. Lead concentrations in earthworms did not differ among functional groups but were significantly higher in urban individuals than in rural ones. Concentrations in outermost tail feathers, breast feathers and blood were significantly higher in urban blackbirds (7.75+/-4.50, 3.15+/-1.77 and 0.15+/-0.09 microg/g, respectively) than in rural individuals. In urban blackbirds, concentrations in washed and unwashed outermost tail feathers allowed estimating the external contamination (probably due to deposition of dusts and/or to excretion of the uropygial gland) at 37% of the total Pb concentration of the unwashed feathers. Remaining 63% should be linked to food chain transfer of persistent Pb from urban soils. Among the 23 sampled blackbirds, 4 of them (3 in the urban site and 1 in the rural site) exhibited blood Pb concentrations higher than the benchmark value (0.20 microg/g) related to subclinical and physiological effects in birds. Variations in body condition index were not correlated to Pb concentrations in blackbird tissues. Present results suggest that Pb may still be of environmental concern for blackbirds in urban areas because of the persistence of Pb in soils and its transfer through the food chain.

Animals↗

Food consumption in rural and urban Tanzania.

Food consumption of 177 rural and 94 urban subjects (98 aged 12 years, 105 aged 35-44 years, and 68 aged 65-74 years) was studied in rural and urban Ilala district, Dar-es-Salaam, Tanzania, to characterize rural-urban differences in the meal and snack patterns and intakes of energy and nutrients. Food consumption of each subject was studied using 24 h dietary recall once during the rainy season and once during the dry season. Micro Nutrica PC database, expanded with East African food composition tables, was used in the nutrient intake analyses. All urban and 92% of rural subjects had three daily meals, and snacks were as commonly eaten in both areas of the survey. Foods of animal origin, e.g. meat and milk, were seldom used by the rural subjects. The WHO/FAO recommended minimal daily allowances of energy and protein were not reached by 26 and 15% of the rural subjects, respectively (10 and 4% of the urban subjects). Mean intake of folic acid by rural subjects was clearly below that of the urban subjects. Intakes of sucrose, mono- and disaccharides combined, polysaccharides, fibre and cholesterol differed markedly in all age groups in rural and urban circumstances (P < 0.05). Intake of fat and saturated fat was extremely low in all age groups, particularly in the rural subjects. The data suggest that (sub)clinical protein-energy malnutrition is prevelant in Tanzania, and that the high intakes of sucrose and cholesterol and the low intake of fibre by the urban subjects may increase the prevalence of dental caries and cardiovascular diseases in that population.

Adult↗

Prevalence of wheeze and asthma and relation to atopy in urban and rural Ethiopia.

BACKGROUND: Asthma and allergy in developing countries may be associated with adoption of an urbanised "western" lifestyle. We compared the rates of asthma symptoms and atopy in urban populations in Jimma, southwest Ethiopia, at an early stage of economic development with those among the population of remote, rural, subsistence areas, and assessed the potential role of environmental aetiological factors leading to the differences. METHODS: Information on wheeze of 12 months' duration, diagnosed asthma, and cough for 3 months of the year was gathered by questionnaire in random household samples of 9844 people from urban Jimma and of 3032 from rural areas. Atopy was defined by allergen skin-test response to Dermatophagoides pteronyssinus and mixed threshings measured in a one-in-four subsample of those aged 5 years and older from both groups. FINDINGS: All respiratory symptoms were rare in children and were significantly less common overall in the rural than in urban group (wheeze odds ratio 0.31 [95% CI 0.22-0.43], p < 0.0001). Asthma was reported by 351 (3.6%) of the urban group, with a median reported duration of 8.5 years (IQR 4-17 years) that was unrelated to age. Atopy was a strong risk factor for asthma in urban Jimma. In the rural areas, skin sensitivity to mixed threshings was only slightly less common than in urban Jimma (0.67 [0.40-1.12], p = 0.13), whereas sensitivity to D pteronyssinus was significantly more common (3.24 [2.40-4.38], p < 0.0001), and since none of the 119 atopic individuals in the rural area reported wheeze or asthma, atopy was possibly associated with a reduction in the risk of disease among this group. Wheeze or D pteronyssinus sensitivity were positively associated with housing style, bedding materials, and use of malathion insecticide, but no single factor accounted for the urban-rural differences. INTERPRETATION: Wheeze and asthma are especially rare in rural subsistence areas, and atopy may be associated with a reduced prevalence of these symptoms in this environment. In urban Jimma, self-reported asthma seemed to emerge as a clinical problem about 10 years before our study began, which is consistent with an effect of new environmental exposures. The factor or factors leading to the increase in asthma and allergy have not been identified, although exposures related to general changes in the domestic environment are likely to be involved.

Adolescent↗

Estimating long-term population exposure to ozone in urban areas of Europe.

Tropospheric ozone concentrations regarded as harmful for human health are frequently encountered in Central Europe in summertime. Although ozone formation generally results from precursors transported over long distances, in urban areas local effects, such as reactions due to nearby emission sources, play a major role in determining ozone concentrations. Europe-wide mapping and modeling of population exposure to high ozone concentrations is subject to many uncertainties, because small-scale phenomena in urban areas can significantly change ozone levels from those of the surroundings. Currently the integrated assessment modeling of European ozone control strategies is done utilizing the results of large-scale models intended for estimating the rural background ozone levels. This paper presents an initial study on how much local nitrogen oxide (NOx) concentrations can explain variations between large-scale ozone model results and urban ozone measurements, on one hand, and between urban and nearby rural measurements, on the other. The impact of urban NOx concentrations on ozone levels was derived from chemical equations describing the ozone balance. The study investigated the applicability of the method for improving the accuracy of modeled population exposure, which is needed for efficient control strategy development. The method was tested with NOx and ozone measurements from both urban and rural areas in Switzerland and with the ozone predictions of the large-scale photochemical model currently used in designing Europe-wide control strategies for ground-level ozone. The results suggest that urban NOx levels are a significant explanatory factor in differences between urban and nearby rural ozone concentrations and that the phenomenon could be satisfactorily represented with this kind of method. Further research efforts should comprise testing of the method in more locations and analyzing the performance of more widely applicable ways of deriving the initial parameters.

Air Pollutants↗

Rural-urban differences in the distribution of parent-reported risk factors for substance use among young adolescents.

PURPOSE: We examined rural-urban differences in cumulative risk for youth substance use. A recent report [National Center on Addiction and Substance Abuse (CASA) 2000] found that the rural-urban distribution of substance use and known risk factors for substance use differed; in many cases rural youth showed higher levels of use, as well as higher levels of risk factors. The current investigation, while not directly examining substance use, further examined rural-urban differences in the distribution of risk factors for youth substance use, based on information from parent reports. METHOD: Study 1 data were collected from a random sample of Midwestern parents (n = 339) with a young adolescent between the ages of 11 and 13 years. Study 2 data were collected from a second sample of Midwestern parents (n = 593). RESULTS: Analyses of rural-urban comparisons demonstrated higher levels of cumulative risk among rural youth. An evaluation of the sensitivity of the analysis to rural-urban classification schemes indicated that the findings were robust, but that there was some minor variation in rural-urban differences by classification scheme. IMPLICATIONS: Results contribute to an explanation of findings from earlier reports of rural-urban differences in substance use, and suggest directions for future research on rural-urban distributions of youth risk factors.

Adolescent↗

Comparison of positive allergy skin tests among asthmatic children from rural and urban areas living within small geographic area.

BACKGROUND: Evidence of increased asthma and allergic response among urban versus rural residents has been reported. OBJECTIVE: To evaluate the prevalence of allergic response among asthmatic children from urban and rural areas living within close proximity. METHODS: In all, 448 asthmatic children from urban (363) and rural (85) areas were studied. The study group consisted of 234 9-year-olds and 214 12-year-olds. A health questionnaire was completed on each child who subsequently underwent allergic skin prick tests (SPTs). RESULTS: There was significantly more positive SPT response to house-dust mite, mold, cat, and cypress among asthmatic children from urban areas compared with children living in rural areas: 58.3% versus 37.6%, 46.1% versus 31.8%, 17.45 versus 5.9%, and 26.2% versus 15.3%, respectively. Positive SPT for indoor allergens were significantly greater among asthmatic urban residents than asthmatic rural residents: 63.3% versus 45.5%, respectively (P < 0.02). Positive SPT response to all the allergens checked was higher among the 12-year-old age group when compared with the 9-year-olds, 34.6% versus 22.7%, respectively (P = 0.05). CONCLUSIONS: Allergic response measured by SPT is significantly more common among asthmatic children from urban areas as opposed to rural, even though both areas are within small distance of one another. Further, asthmatic children living in urban areas demonstrated more allergic response to both indoor and outdoor allergens. The allergic response tends to increase with increased age in both urban and rural asthmatic children.

Age Factors↗

The impact of rural-urban migration on under-two mortality in India.

This paper examines the impact of rural-urban migration on under-two mortality in India, using data from the 1992/93 Indian National Family Health Survey. Multilevel logistic models are fitted for mortality in three age groups: neonatal, early post-neonatal, and late post-neonatal and toddler. Migration status was not a significant determinant of mortality in any of the three age groups. Further analysis shows that a relationship between migration status and mortality exists when socioeconomic and health utilization variables are omitted from the models. The relationship between migration and mortality is thus explained by differences in socioeconomic status and use of health services between rural-urban migrant and nonmigrant groups. The selectivity of rural-urban migrants on socioeconomic characteristics creates mortality differentials between rural-urban migrants and rural non-migrants. Problems faced by migrants in assimilating into urban societies create mortality differentials between rural-urban migrants and urban non-migrants. These results highlight the need to target migrants in the provision of health services, and demonstrate that rural areas continue to have the highest levels of infant-child mortality. Further research is needed to understand the health care needs of rural-urban migrants in order to inform the provision of appropriate health care.

Adolescent↗

The impact of variation in trauma care times: urban versus rural.

STUDY OBJECTIVES: To document the existence and nature of variation in times to trauma care between urban and rural locations; to assess the impact of identified variations on outcome. DESIGN: Retrospective case review. SETTING: Washington state, 1986. PARTICIPANTS: Motor-vehicle-collision fatalities. METHODS: Previously unreported definitions of urban and rural location and possibly preventable death were used to conduct a comparative analysis of urban and rural fatalities. Trauma care times in the prehospital and the emergency department (ED) phases of care were abstracted. Their relationships to corresponding crude death rates and possibly preventable death rates also were examined. RESULTS: Prehospital times averaged two times longer in rural locations than in urban areas. Fist-physician contact in the ED averaged six times longer in rural locations than in urban settings. Concomitantly, the crude death rate in rural settings was three times that of the urban areas. The overall possibly preventable death rate was double the urban rates in rural incidents. When stratified by phase of care, rate of possibly preventable death showed no urban/rural variation for the prehospital phase, but was three times greater for the ED phase in rural areas than in urban ones. CONCLUSIONS: Trauma care times and adverse outcome appear to be associated. Allocation of resources to decrease length of and geographic variation in time to definitive care, particularly in the ED phase, seems appropriate.

Accidents, Traffic↗

Food variety, socioeconomic status and nutritional status in urban and rural areas in Koutiala (Mali).

OBJECTIVE: The purpose of this study was to analyse the associations between the food variety score (FVS), dietary diversity score (DDS) and nutritional status of children, and to assess the associations between FVS, DDS and socioeconomic status (SES) on a household level. The study also assessed urban and rural differences in FVS and DDS. DESIGN: Cross-sectional studies in 1994/95, including a simplified food frequency questionnaire on food items used in the household the previous day. A socioeconomic score was generated, based on possessions in the households. Weight and height were measured for all children aged 6-59 months in the households, and anthropometric indices were generated. SUBJECTS AND SETTING: Three hundred and twenty-nine urban and 488 rural households with 526 urban and 1789 rural children aged 6-59 months in Koutiala County, Sikasso Region, Mali. RESULTS: Children from urban households with a low FVS or DDS had a doubled risk (OR>2) for being stunted and underweight. Those relations were not found in the rural area. There was an association between SES and both FVS and DDS on the household level in both areas. The FVS and DDS in urban households with the lowest SES were higher than the FVS and DDS among the rural households with the highest SES. CONCLUSIONS: Food variety and dietary diversity seem to be associated with nutritional status (weight/age and height/age) of children in heterogeneous communities, as our data from urban areas showed. In rural areas, however, this association could not be shown. Socioeconomic factors seem to be important determinants for FVS and DDS both in urban and rural areas. FVS and DDS are useful variables in assessing the nutritional situation of households, particular in urban areas.

Body Height↗

Obesity in a rural and an urban Palestinian West Bank population.

OBJECTIVE: To compare the prevalence of obesity, household food consumption patterns, physical activity patterns and smoking between a rural and an urban community in the Palestinian West Bank and to describe the associations of the latter factors with body mass index (BMI). DESIGN: A population-based cross-sectional survey in a rural and an urban Palestinian West Bank community. SUBJECTS: A total of 549 women and 387 men aged 30-65 y, excluding pregnant women. MEASUREMENTS: Obesity was defined as BMI >/=30 kg/m(2). RESULTS: The prevalence of obesity was 36.8 and 18.1% in rural women and men, respectively, compared with 49.1 and 30.6% in urban women and men, respectively. The mean difference (s.e) in BMI levels was 1.6 (0.52) kg/m(2) between urban and rural women and 0.9 (0.46) kg/m(2) in men. At the household level, the mean energy consumption from 25 selected food items was 13.8 MJ (3310 kcal)/consumption unit/day in the rural community compared to 14.5 MJ (3474 kcal)/consumption unit/day in the urban community (P=0.021). BMI was positively associated with age in both men and women and with urban residence in women. BMI was negatively associated with smoking and physical activity in men and with educational level in women. CONCLUSION: BMI was associated with urban residence in women after adjusting for age, smoking, education, physical activity and nutrition-related variables, suggesting that the differences in the conventional determinants of obesity could not fully explain the difference in the prevalence of obesity between the two communities. Among men, the measured determinants explained the rural-urban differences in BMI.

Adipose Tissue↗