Objective: Assess the impact of the rural food environment on the eating behaviors and BMI of rural low-income children. Method: Statewide (Maine, 2009) household survey of parents of children on Medicaid (n=1722), oversampled in six rural communities, resulting in n=272 for six target communities. Food environment measured using modified Nutrition Environment Measures Survey in Stores (NEMS-S) for 46 retail food outlets. Multi-variate analysis assessed factors affecting home food environment, child\u27s eating behavior and BMI. Results: Home food behaviors (how often: family eats together, child eats breakfast, vegetables served) and parent food consumption were significantly associated with children\u27s healthy eating behaviors. The only significant predictor of childhood obesity was parent eating behavior. We observed several alternative strategies such as hunting, gathering and buying from local farmers. Parents who drove over 20 miles to shop were found to shop at stores with higher NEMS scores as compared to parents who drove shorter distances.Conclusion: Defining and identifying food deserts is not a promising approach to measuring the rural food environment due to long distance trips, careful price shopping, and local, alternative strategies. Strategies to place healthier food in the home should be combined with interventions directed at parents\u27 and families\u27 eating behaviors
