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Item Applying the school health index to determine the physical activity and nutrition programs available to rural, elementary/middle (PK-8) students in Montana(Montana State University - Bozeman, College of Nursing, 2015) Addison, Lauren Marie; Chairperson, Graduate Committee: Charlene WintersObesity and overweight are the second and third leading causes of preventable death in the United States, accounting for an estimated 200,000 yearly deaths and $147 billion spent annually in direct medical costs. In 2009-2010, over 12.5 million American children and adolescents between the ages of 2-19 were obese. In Montana, the obesity rate has increased more than 80% over the last 15 years with 12.2% of its 2-5 year olds being obese. Growing attention has been paid to the increasing prevalence of obesity among rural children. Though numerous studies have identified rurality as a risk factor for childhood obesity, the causes for this relationship require more exploration. This quantitative research study utilized a descriptive design to determine the physical activity and nutrition programs available to rural, elementary/middle (PK-8) students in Montana. A non-random, convenience sample of 217 rural, elementary/middle (PK-8) school principals with less than 200 students in attendance were asked to participate in this study. Data were collected via electronic surveys, and questions were drawn from the CDC's School Health Index for elementary schools. Data were recorded and analyzed using Qualtrics software. Forty-two eligible surveys were returned for a response rate of 19.4%. Those participating counties in Central and Northeastern Montana with the lowest population densities scored the highest on the physical education/activity module, whereas Northwestern Montana had the highest population density and the highest score on the nutrition module; Southeastern Montana had the lowest scores on both modules. Students have greater access to nutritional services than physical education/activity programs; however, the average module scores from all of the schools combined indicate these schools generally have more strengths than weaknesses when it comes to the physical education/activity and nutritional services they offer. More research on the relationship between rurality and childhood obesity, community influences, and barriers to healthy eating and physical activity in rural areas is needed. Primary care providers in rural areas should use every opportunity to screen, counsel and initiate early interventions to combat childhood obesity, and they should consider the unique factors contributing to obesity in their area to better promote physical activity and nutrition.