Background: Little is known about the patterning of neighborhood characteristics, beyond the basic urban, rural, suburban trichotomy, and its impact on physical activity (PA) and overweight.

Methods: Nationally representative data (National Longitudinal Study of Adolescent Health, 1994-1995, n = 20,745) were collected. Weight, height, PA, and sedentary behavior were self-reported. Using diverse measures of the participants' residential neighborhoods (e.g., socioeconomic status, crime, road type, street connectivity, PA recreation facilities), cluster analyses identified homogeneous groups of adolescents sharing neighborhood characteristics. Poisson regression predicted relative risk (RR) of being physically active (five or more bouts/week of moderate to vigorous PA) and overweight (body mass index equal or greater than the 95th percentile, Centers for Disease Control and Prevention/National Center for Health Statistics growth curves).

Results: Six robust neighborhood patterns were identified: (1) rural working class; (2) exurban; (3) newer suburban; (4) upper-middle class, older suburban; (5) mixed-race urban; and (6) low-socioeconomic-status (SES) inner-city areas. Compared to adolescents living in newer suburbs, those in rural working-class (adjusted RR[ARR] = 1.38, 95% confidence interval [CI] = 1.13-1.69), exurban (ARR = 1.30, CI = 1.04-1.64), and mixed-race urban (ARR = 1.31, CI = 1.05-1.64) neighborhoods were more likely to be overweight, independent of individual SES, age, and race/ethnicity. Adolescents living in older suburban areas were more likely to be physically active than residents of newer suburbs (ARR = 1.11, CI = 1.04-1.18). Those living in low-SES inner-city neighborhoods were more likely to be active, though not significantly so, compared to mixed-race urban residents (ARR = 1.09, CI = 1.00-1.18).

Conclusions: These findings demonstrate disadvantageous associations between specific rural and urban environments and behavior, illustrating important effects of the neighborhood on health and the inherent complexity of assessing residential landscapes across the United States. Simple classical urban-suburban-rural measures mask these important complexities.