Introduction to the Active Living Research Reference List January – July 2008

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A. L. Bedimo-Rung, J. L. Thomson, A. J. Mowen, J. Gustat, B. J. Tompkins, P. K. Strikmiller and M. S. Sothern. (2008). The condition of neighborhood parks following Hurricane Katrina: development of a Post-Hurricane Assessment instrument. J Phys Act Health. 5, 45-57.

BACKGROUND: Parks provide environments for physical activity, yet little is known about how natural disasters affect them or how these disasters alter physical activity. Our objectives were to (1) describe the development of an instrument to assess park conditions following a hurricane and (2) document the conditions of New Orleans' parks 3 and 6 months after Hurricane Katrina. METHODS: A Post-Hurricane Assessment (PHA) instrument was developed and implemented in 54 parks 3 and 6 months post-hurricane. RESULTS: Summary scores of the Park Damage Index and the Neighborhood Damage Index showed improvement between 3 and 6 months of data collection. Parks and neighborhoods most affected by the hurricane were located in the most- and least-affluent areas of the city. CONCLUSION: The PHA proved to be a promising tool for assessing park conditions in a timely manner following a natural disaster and allowed for the creation of summary damage scores to correlate to community changes.

J. E. Boone, P. Gordon-Larsen, J. D. Stewart and B. M. Popkin. (2008). Validation of a GIS facilities database: quantification and implications of error. Ann Epidemiol. 18, 371-7.

PURPOSE: To validate a commercial database of community-level physical activity facilities that can be used in future research examining associations between access to physical activity facilities and individual-level physical activity and obesity. METHODS: Physical activity facility characteristics and locations obtained from a commercial database were compared to a field census conducted in 80 census block groups within two U.S. communities. Agreement statistics, agreement of administratively defined neighborhoods, and distance between locations were used to quantify count, attribute, and positional error. RESULTS: There was moderate agreement (concordance: nonurban: 0.39; urban: 0.46) of presence of any physical activity facility and poor to moderate agreement (kappa range: 0.14 to 0.76) of physical activity facility type. The mean Euclidean distance between commercial database versus field census locations was 757 and 35 m in the nonurban and urban communities, respectively. However, 94% and 100% of nonurban and urban physical activity facilities, respectively, fell into the same 5-digit ZIP code, dropping to 92% and 98% in the same block group and 71% along the same street. CONCLUSIONS: Our findings suggest that the commercial database of physical activity facilities may contain appreciable error, but patterns of error suggest that built environment-health associations are likely biased downward.

M. J. Bryant, D. S. Ward, D. Hales, A. Vaughn, R. G. Tabak and J. Stevens. (2008). Reliability and validity of the Healthy Home Survey: A tool to measure factors within homes hypothesized to relate to overweight in children. International Journal Of Behavioral Nutrition And Physical Activity. 5,

Background: The contribution of the environment to the obesity epidemic is well recognized. Parents have control over their home environment and can, therefore, support healthy dietary and activity habits in their children by manipulating factors such as access to energy-dense foods, availability of physical activity equipment, and restricting screen time. This paper describes the development of the Healthy Home Survey and its reliability and validity. The Healthy Home Survey was designed to assess characteristics of the home environment that are hypothesized to influence healthy weight behaviors in children including diet and physical activity. Methods: We recruited 85 families with at least one child between 3-8 years. The Healthy Home Survey was administered to parents via telephone and repeated in a random sample of 45 families after 7 days. In-home observations were performed within 14 days of the first Healthy Home Survey interview. Percent agreement, Kappa statistics, Intra-class correlation coefficients and sensitivity analyses were used to evaluate reliability and validity evidence. Results: Reliability and validity estimates for the Healthy Home Survey were varied, but generally high (0.22-1.00 and 0.07-0.96 respectively), with lower scores noted for perishable foods and policy items. Lower scores were likely related to actual change in the perishable foods present and the subjective nature or clarity of policy questions and response categories. Conclusion: Initial testing demonstrated that the Healthy Home Survey is a feasible, reliable, and valid assessment of the home environment; however, it has also highlighted areas that need improvement. The Healthy Home Survey will be useful in future research exploring the relationship between the home environment and child weight.

M. W. Chang, R. Brown and S. Nitzke. (2008). Scale development: factors affecting diet, exercise, and stress management (FADESM). BMC Public Health. 8, 76.

BACKGROUND: The objective of this study was to develop scales measuring personal and environmental factors that affect dietary fat intake behavior, physical activity, and stress management in low-income mothers. METHODS: FADESM (factors affecting diet, exercise, and stress management) scales were developed using the Social Cognitive Theory to measure personal (outcome expectancies, self-efficacy, emotional coping response) and environmental (physical environment, social environment, situation) factors affecting dietary fat intake behavior, physical activity, and stress management. Low-income African American and white mothers were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children in three counties in Michigan. In Phase one, 45 mothers completed individual cognitive interviews. Content analyses were performed. In Phase two, items modified from the cognitive interviews were administered to 216 mothers. Factor analysis and multiple indicators/multiple causes were performed. RESULTS: Results of cognitive interviews were used to revise items for the instrument that was tested in Phase two. The factor solution revealed 19 dimensions to measure personal and environmental factors affecting dietary fat intake behavior (three dimensions), physical activity (eight dimensions), and stress management (eight dimensions). Results of multiple indicators/multiple causes model showed scale invariance. Of 19 dimensions, 15 had Cronbach alpha between 0.76 and 0.94 and four were between 0.66 and 0.69. All dimensions had composite construct reliability scores between 0.74 to 0.97 and satisfactory construct and discriminant validities. CONCLUSION: The theory-based FADESM scales have documented good validity and reliability for measuring factors affecting dietary fat intake behavior, physical activity, and stress management in low-income women. Results of this study support the use of these scales with low-income African American and white mothers in community settings.

G. K. W. Chin, K. P. Van Niel, B. Giles-Corti and M. Knuiman. (2008). Accessibility and connectivity in physical activity studies: The impact of missing pedestrian data. Preventive Medicine. 46, 41-45.

Objective. One important characteristic in physical activity research into the built environment is network connectivity, usually calculated using street networks. However, a true pedestrian network may have very different connectivity than a street network. This study, conducted in 2004, examines the difference in walkability analyses when street networks versus pedestrian networks are used for four metropolitan suburbs in Perth, Western Australia. Methods. A street network of Perth was used to represent the current standard of data for walkability analyses. Aerial photography from 2003 was used to create a pedestrian network, which incorporated pedestrian footpaths into the street network. The street and pedestrian networks were compared using three measures of connectivity: Pedsheds, link node ratio and pedestrian route directness. Results. A comparison of the results using street versus pedestrian networks showed very different outcomes for conventional neighbourhood designs. Connectivity measures for conventional neighbourhoods improved up to 120% with the addition of pedestrian networks, although traditional neighbourhoods still had slightly better connectivity values overall. Conclusion. The true pedestrian network increases the connectivity of a neighbourhood and may have significant impact on these measures, especially in neighbourhoods with conventional street designs. It is critical that future studies incorporate pedestrian networks into their analyses.

H. E. Cutt, B. Giles-Corti, M. W. Knulman and T. J. Pikora. (2008). Physical activity behavior of dog owners: development and reliability of the Dogs and Physical Activity (DAPA) tool. J Phys Act Health. 5 Suppl 1, S73-89.

BACKGROUND: This study aimed to develop a reliable instrument, the Dogs and Physical Activity (DAPA) tool, for measuring important attributes and scales relating to the dog-walking behavior of dog owners. METHODS: Items measuring dog-specific individual, social environmental, physical environmental, and policy-related factors that affect dog owners' walking with their dogs were assessed for test-retest reliability. Factor analysis was undertaken to demonstrate that the collection of test items had underlying constructs consistent with the theoretical framework. RESULTS: DAPA-tool items had test-retest reliability scores >.7, indicating a high level of stability. Distinct general and dog-specific constructs of subscales measuring dog-supportive features of parks, barriers to dog walking, and behavioral beliefs about the outcomes of regular dog walking were demonstrated through factor analysis. CONCLUSIONS: The DAPA tool is the first comprehensive, reliable tool for measuring important attributes and scales relating to dog owners' physical activity and the context-specific factors that affect owners' walking with their dogs.

D. M. DeJoy, M. G. Wilson, R. Z. Goetzel, R. J. Ozminkowski, S. H. Wang, K. M. Baker, H. M. Bowen and K. J. Tully. (2008). Development of the Environmental Assessment Tool (EAT) to measure organizational physical and social support for worksite obesity prevention programs. Journal Of Occupational And Environmental Medicine. 50, 126-137.

Objective: To describe the development, reliability, and validity of the Environmental Assessment Tool (EAT) for assessing worksite physical and social environmental support for obesity prevention. Methods: The EAT was developed using a multistep process. Inter-rater reliability was estimated via Kappa and other measures. Concurrent and predictive validity were estimated using site-level correlations and person-level multiple regression analyses comparing EAT scores and employee absenteeism and health care expenditures. Results: Results show high inter-rater reliability and concurrent validity for many measures and predictive validity for absenteeism expenditures. Conclusions: The primary use of the FAT is as a physical and social environment assessment tool for worksite obesity prevention efforts. It can be used as a reliable and valid means to estimate relationships between environmental interventions and absenteeism and medical expenditures, provided those expenditures are for the same year that the EAT is administered.

C. D. Economos, J. M. Sacheck, K. Kwan Ho Chui, L. Irizzary, J. Guillemont, J. J. Collins and R. R. Hyatt. (2008). School-based behavioral assessment tools are reliable and valid for measurement of fruit and vegetable intake, physical activity, and television viewing in young children. J Am Diet Assoc. 108, 695-701.

Interventions aiming to modify the dietary and physical activity behaviors of young children require precise and accurate measurement tools. As part of a larger community-based project, three school-based questionnaires were developed to assess (a) fruit and vegetable intake, (b) physical activity and television (TV) viewing, and (c) perceived parental support for diet and physical activity. Test-retest reliability was performed on all questionnaires and validity was measured for fruit and vegetable intake, physical activity, and TV viewing. Eighty-four school children (8.3+/-1.1 years) were studied. Test-retest reliability was performed by administering questionnaires twice, 1 to 2 hours apart. Validity of the fruit and vegetable questionnaire was measured by direct observation, while the physical activity and TV questionnaire was validated by a parent phone interview. All three questionnaires yielded excellent test-retest reliability (P<0.001). The majority of fruit and vegetable questions and the questions regarding specific physical activities and TV viewing were valid. Low validity scores were found for questions on watching TV during breakfast or dinner. These questionnaires are reliable and valid tools to assess fruit and vegetable intake, physical activity, and TV viewing behaviors in early elementary school-aged children. Methods for assessment of children's TV viewing during meals should be further investigated because of parent-child discrepancies.

H. E. Erwin. (2008). Test-Retest Reliability of a Preadolescent Environmental Access to Physical Activity Questionnaire. Journal of Physical Activity & Health. 5, S62.

Background: Physical activity behavior is an important aspect of overall health, and it is important to understand determinants of physical activity in order for children to accumulate the recommended levels. The ecological-systems theory describes the relationship between individuals and their contexts, suggesting that environment affects physical activity behaviors. Researchers should measure children's access to physical activity to determine environmental influences. At the time of data collection, however, no reliable questionnaires had been created for measuring children's access to physical activity. Methods: Students from grades 4 and 5 completed a physical activity environmental-access questionnaire on 2 occasions, approximately 7 to 10 days apart. Results: The questionnaire appeared appropriate for children age 9 to 12. The lowest reliability was found with items located in the school environment. Conclusions: This questionnaire is a suitable tool for examining children's physical activity supports and inhibitors.

K. R. Evenson, B. Neelon, S. C. Ball, A. Vaughn and D. S. Ward. (2008). Validity and Reliability of a School Travel Survey. Journal of Physical Activity & Health. 5, S1.

Background: Despite the growing interest in active (ie, nonmotorized) travel to and from school, few studies have explored the measurement properties to assess active travel. We evaluated the criterion validity and test-retest reliability of a questionnaire with a sample of young schoolchildren to assess travel to and from school, including mode, travel companion, and destination after school. Methods: To assess test-retest reliability, 54 children age 8 to 11 years completed a travel survey on 2 consecutive school days. To assess criterion validity, 28 children age 8 to 10 years and their parents completed a travel survey on 5 consecutive weekdays. Results: Test-retest reliability of all questions indicated substantial agreement. The questions on mode of transport, where you will go after school, and how you will get there also displayed substantial agreement between parental and child reports. Conclusions: For this population, a questionnaire completed by school-age children to assess travel to and from school, including mode, travel companion, and destination after school, was reliably collected and indicated validity for most items when compared with parental reports.

M. L. Gattshall, J. A. Shoup, J. A. Marshall, L. A. Crane and P. A. Estabrooks. (2008). Validation of a survey instrument to assess home environments for physical activity and healthy eating in overweight children. International Journal Of Behavioral Nutrition And Physical Activity. 5,

Background: Few measures exist to measure the overall home environment for its ability to support physical activity (PA) and healthy eating in overweight children. The purpose of this study was to develop and test the reliability and validity of such a measure. Methods: The Home Environment Survey (HES) was developed to reflect availability, accessibility, parental role modelling, and parental policies related to PA resources, fruits and vegetables (F&V), and sugar sweetened drinks and snacks (SS). Parents of overweight children (n = 219) completed the HES and concurrent behavioural assessments. Children completed the Block Kids survey and wore an accelerometer for one week. A subset of parents (n = 156) completed the HES a second time to determine test-retest reliability. Finally, 41 parent dyads living in the same home (n = 41) completed the survey to determine inter-rater reliability. Initial psychometric analyses were completed to trim items from the measure based on lack of variability in responses, moderate or higher item to scale correlation, or contribution to strong internal consistency. Inter-rater and test-retest reliability were completed using intraclass correlation coefficients. Validity was assessed using Pearson correlations between the HES scores and child and parent nutrition and PA. Results: Eight items were removed and acceptable internal consistency was documented for all scales (alpha =.66-84) with the exception of the F&V accessibility. The F&V accessibility was reduced to a single item because the other two items did not meet reliability standards. Test-retest reliability was high (r >.75) for all scales. Inter-rater reliability varied across scales (r =.22-.89). PA accessibility, parent role modelling, and parental policies were all related significantly to child (r =.14-.21) and parent (r =.15-.31) PA. Similarly, availability of F&V and SS, parental role modelling, and parental policies were related to child (r =.14-36) and parent (r =.15-26) eating habits. Conclusion: The HES shows promise as a potentially valid and reliable assessment of the physical and social home environment related to a child's physical activity and eating habits.

G. R. McCormack, E. Cerin, E. Leslie, L. Du Toit and N. Owen. (2008). Objective versus perceived walking distances to destinations - Correspondence and predictive validity. Environment And Behavior. 40, 401-425.

Judgments concerning features of environments do not always correspond accurately with objective measures of those same features. Moreover, perceived and objectively assessed environmental attributes, including proximity of destinations, may influence walking behavior in different ways. This study compares perceived and objectively assessed distance to several different destinations and examines whether correspondence between objective and perceived distance is influenced by age, gender, neighborhood walkability, and walking behavior. Distances to most destinations close to home are overestimated, whereas distances to those farther away are underestimated. Perceived and objective distances to certain types of destinations are differentially associated with walking behavior. Perceived environmental attributes do not consistently reflect objectively assessed attributes, and both appear to have differential effects on physical activity behavior.

J. L. Nasar. (2008). Assessing perceptions of environments for active living. American Journal Of Preventive Medicine. 34, 357-363.

Background: Substantial research has been done on the relationship of physical environments to active living, much of it using observational measures of physical properties. Although this research is important, it produces an incomplete picture. Perceptions of environmental factors may affect physical activity. There is particular value in learning about people's perceptions of environmental factors that are associated with increased or decreased likelihood of physical activity. Methods: The present paper surveys and evaluates various options for measuring perceptions of specific environments and alternatives for study designs and methods. Referring to the relevant studies and concepts in environmental psychology, environmental perception, and related disciplines, it identifies and evaluates the measurement methods. Results: The measurement of environmental perceptions must take into consideration the selection of respondents, measurement of environmental variables, sampling and mode of presentation of the environmental stimuli, and response measures. Conclusions: Research can build on current knowledge of environmental perception to explore measures and methods of particular relevance to understanding people's likelihood of using places for physical activity.

D. Ogilvie, R. Mitchell, N. Mutrie, M. Petticrew and S. Platt. (2008). Perceived characteristics of the environment associated with active travel: development and testing of a new scale. International Journal Of Behavioral Nutrition And Physical Activity. 5,

Background: Environmental characteristics may be associated with patterns of physical activity. However, the development of instruments to measure perceived characteristics of the local environment is still at a comparatively early stage, and published instruments are not necessarily suitable for application in all settings. We therefore developed and established the test-retest reliability of a new scale for use in a study of the correlates of active travel and overall physical activity in deprived urban neighbourhoods in Glasgow, Scotland. Methods: We developed and piloted a 14-item scale based on seven constructs identified from the literature (aesthetics, green space, access to amenities, convenience of routes, traffic, road safety and personal safety). We administered the scale to all participants in a random postal survey (n = 1322) and readministered the scale to a subset of original respondents (n = 125) six months later. We used principal components analysis and Varimax rotation to identify three principal components (factors) and derived summary scores for subscales based on these factors. We examined the internal consistency of these subscales using Cronbach's alpha and examined the test-retest reliability of the individual items, the subscale summary scores and an overall summary neighbourhood score using a combination of correlation coefficients and Cohen's kappa with and without weighting. Results: Public transport and proximity to shops were the items most likely to be rated positively, whereas traffic volume, traffic noise and road safety for cyclists were most likely to be rated negatively. Three principal components - 'safe and pleasant surroundings', 'low traffic' and 'convenience for walking' - together explained 45% of the total variance. The test-retest reliability of individual items was comparable with that of items in other published scales (intraclass correlation coefficients (ICCs) 0.34-0.70; weighted Cohen's kappa 0.24-0.59). The overall summary neighbourhood score had acceptable internal consistency (Cronbach's alpha 0.72) and test-retest reliability (ICC 0.73). Conclusion: This new scale contributes to the development of a growing set of tools for investigating the role of perceived environmental characteristics in explaining or mediating patterns of active travel and physical activity.

H. M. Seagle, J. B. Moore and K. D. DuBose. (2008). An assessment of the walkability of two school neighborhoods in Greenville, North Carolina. J Public Health Manag Pract. 14, e1-8.

Walking to school provides the opportunity for increasing physical activity and for improving weight status in youth. Social ecological theory recognizes the link between supportive built environments and increased walking. To promote walking to school as a way to increase physical activity in youth, it is important to begin by assessing the presence and quality of sidewalks in school neighborhoods and then to advocate for improvements. The purpose of this study is to demonstrate the assessment of the walkability of two school neighborhood areas, using an evaluation process, which is designed for use by lay community members, that produces maps to disseminate the assessment findings to decision makers. A validated and reliable audit instrument was used to assess the walkability of 114 road segments in the immediately adjacent student enrollment areas surrounding two elementary schools. Ten variables characterizing the transportation and pedestrian environment were measured and used to calculate a walkability score for each road segment. Color-coded maps of the walkability scores for each road segment were created to display the patterns of walkability. Sidewalks were absent in 67 percent and 75 percent of the road segments surrounding the two schools, respectively. The maps reveal that the very few suitable roads for walking are isolated by networks of streets with no sidewalks.

J. R. Sirard, M. C. Nelson, M. A. Pereira and L. A. Lytle. (2008). Validity and reliability of a home environment inventory for physical activity and media equipment. International Journal Of Behavioral Nutrition And Physical Activity. 5,

Background: Little is known about how the home environmental supports physical activity and screen media usage. The purpose of this study was to develop and test the reliability and validity of a self-report instrument to comprehensively reflect the availability and accessibility of physical activity and screen media equipment in the home environment. Methods: Ten families participated in the initial field testing to provide feedback for instrument development. Thirty one adult participants, each of whom had at least one child 10 -17 years old, completed two Physical Activity and Media Inventory (PAMI) instruments. The first PAMI was completed simultaneously, but independently, with a research assistant to assess validity. A second PAMI was completed by the participant one week later to assess reliability. Results: The adult participants were mostly mothers/ female guardians, mean age 38 +/- 7.2 years, mostly Caucasian (52%), college educated (65%), living in single family homes (74%). Test-retest reliability was acceptable to strong for all summary variables (physical activity equipment, ICC = 0.76 to 0.99; media equipment, ICC = 0.72 to 0.96). For validation, reports from participants and research assistants were strongly correlated (physical activity, 0.67 - 0.98; media, 0.79 - 0.96). Compared to participants, research assistants reported a greater percentage of physical activity equipment as "in plain view and easy to get to" and a smaller percentage of items as "put away and difficult to get to". Conclusion: Our results indicate strong evidence for the reliability and validity of the variables calculated from the PAMI. This self report inventory may be useful in assessing the availability of physical activity and screen media equipment in the home environment and could be used in conjunction with other home assessment tools (food availability, parenting styles and feeding practices) to identify obesogenic home environments.

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