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1.  Evaluation of the neighborhood environment walkability scale in Nigeria 
Background
The development of reliable and culturally sensitive measures of attributes of the built and social environment is necessary for accurate analysis of environmental correlates of physical activity in low-income countries, that can inform international evidence-based policies and interventions in the worldwide prevention of physical inactivity epidemics. This study systematically adapted the Neighborhood Environment Walkability Scale (NEWS) for Nigeria and evaluated aspects of reliability and validity of the adapted version among Nigerian adults.
Methods
The adaptation of the NEWS was conducted by African and international experts, and final items were selected for NEWS-Nigeria after a cross-validation of the confirmatory factor analysis structure of the original NEWS. Participants (N = 386; female = 47.2%) from two cities in Nigeria completed the adapted NEWS surveys regarding perceived residential density, land use mix – diversity, land use mix – access, street connectivity, infrastructure and safety for walking and cycling, aesthetics, traffic safety, and safety from crime. Self-reported activity for leisure, walking for different purposes, and overall physical activity were assessed with the validated International Physical Activity Questionnaire (long version).
Results
The adapted NEWS subscales had moderate to high test-retest reliability (ICC range 0.59 –0.91). Construct validity was good, with residents of high-walkable neighborhoods reporting significantly higher residential density, more land use mix diversity, higher street connectivity, more traffic safety and more safety from crime, but lower infrastructure and safety for walking/cycling and aesthetics than residents of low-walkable neighborhoods. Concurrent validity correlations were low to moderate (r = 0.10 –0.31) with residential density, land use mix diversity, and traffic safety significantly associated with most physical activity outcomes.
Conclusions
The NEWS-Nigeria demonstrated acceptable measurement properties among Nigerian adults and may be useful for evaluation of the built environment in Nigeria. Further adaptation and evaluation in other African countries is needed to create a version that could be used throughout the African region.
doi:10.1186/1476-072X-12-16
PMCID: PMC3606828  PMID: 23514561
Built environment; Physical activity; Measurements; Psychometric; Africa
2.  Test-retest reliability of IPAQ environmental- module in an African population 
Background
There is overwhelming evidence of the benefits of physical activity and the physical environment is increasingly recognized as a promising determinant of physical activity participation. The influence of the environment on physical activity has not been evaluated among black Africans and no specific measure exists for assessing environmental factors related to physical activity in an African environment. The IPAQ E- module was designed to assess environmental factors for physical activity participation and was considered to be relevant to all countries regardless of the stage of economic development. The objective of this study was to assess the test- retest reliability of IPAQ E- module in an African population.
Methods
One hundred and three clinical students of a University in Nigeria were invited to participate in the reliability testing of IPAQ E- module. Sixteen of the 17- items on the environmental measure were assessed for test- retest reliability using intraclass correlation coefficient (ICC) with 95% Confidence interval (CI) overall and by gender. The measure addressed items regarding residential density, access to destinations, neighborhood infrastructures, aesthetic qualities, social environment, street connectivity and neighborhood safety.
Results
Of the total respondents, 51.5% were males and 48.5% were females. Overall, the intraclass correlation coefficient (ICC) ranged from 0.43 to 0.91. The item regarding many interesting things to look at (aesthetic) produced the overall highest reliability score (ICC = 0.91, 95% CI = 0.86 – 0.94), while the item regarding safety from crime during the day (neighborhood safety) produced the lowest overall score (ICC = 0.43, 95% CI = 0.26 – 0.57). Reliability of items on neighborhood infrastructures ranged between substantial agreement to almost perfect agreement overall (ICC = 0.66 – 0.88) and by gender (male- ICC = 0.68 – 0.90 and female- ICC = 0.63 – 0.86). The access to destination items (ICC = 0.49 – 0.74), social environment (ICC = 0.62) and street connectivity (ICC = 0.78) all had acceptable reliability overall. Meaningful differences were found between males and females on two items on neighborhood safety and one item on access to destinations.
Conclusion
The test- retest of IPAQ E- module resulted in moderate to almost perfect agreement for most of the items with few meaningful differences by gender. Environmental items of physical activity in an African population exhibited reliability similar to that in other environments. These results suggest that IPAQ E- module may be a useful measure for assessing environmental correlates of physical activity among population in Africa.
doi:10.1186/1479-5868-5-38
PMCID: PMC2531132  PMID: 18680599
3.  Assessing urban and rural neighborhood characteristics using audit and GIS data: derivation and reliability of constructs 
Background
Measures to assess neighborhood environments are needed to better understand the salient features that may enhance outdoor physical activities, such as walking and bicycling for transport or leisure. The purpose of this study was to derive constructs to describe neighborhoods using both primary (neighborhood audit) and secondary (geographic information systems) data.
Methods
We collected detailed information on 10,770 road segments using an audit and secondary data. The road segment sample was randomly split into an exploratory (60%) and validation sample (40%) for cross-validation. Using the exploratory sample (n = 6,388), seven a priori constructs were assessed separately (functionality, safety, aesthetics, destinations, incivilities, territorality, social spaces) by urbanicity using multi-group confirmatory factor analysis (CFA). Additionally, new a posteriori constructs were derived using exploratory factor analysis (EFA). For cross-validation (n = 4,382), we tested factor loadings, thresholds, correlated errors, and correlations among a posteriori constructs between the two subsamples. Two-week test-retest reliability of the final constructs using a subsample of road segments (n = 464) was examined using Spearman correlation coefficients.
Results
CFA indicated the a priori constructs did not hold in this geographic area, with the exception of physical incivilities. Therefore, we used EFA to derive a four-factor solution on the exploratory sample: arterial or thoroughfare, walkable neighborhood, physical incivilities, and decoration. Using CFA on the validation sample, the internal validity for these a posteriori constructs was high (range 0.43 to 0.73) and the fit was acceptable. Spearman correlations indicated the arterial or thoroughfare factor displayed near perfect reliability in both urban and rural segments (r = 0.96). Both the physical incivilities factor and the walkable neighborhood factor had substantial to near perfect reliability in both urban and rural segments (r = 0.77 to 0.78 and r = 0.79 to 0.82, respectively). The decoration factor displayed moderate reliability in urban segments (r = 0.50; 95% CI: 0.38–0.60) and lower reliability in rural segments (r = 0.39; 95% CI: 0.25–0.52).
Conclusion
The results of our analyses yielded four reliably and objectively measured constructs that will be used to explore associations with physical activity in urban and rural North Carolina. These constructs should be explored in other geographic areas to confirm their usefulness elsewhere.
doi:10.1186/1479-5868-6-44
PMCID: PMC2726116  PMID: 19619325
4.  Reliable and valid NEWS for Chinese seniors: measuring perceived neighborhood attributes related to walking 
Background
The effects of the built environment on walking in seniors have not been studied in an Asian context. To examine these effects, valid and reliable measures are needed. The aim of this study was to develop and validate a questionnaire of perceived neighborhood characteristics related to walking appropriate for Chinese seniors (Neighborhood Environment Walkability Scale for Chinese Seniors, NEWS-CS). It was based on the Neighborhood Environment Walkability Scale - Abbreviated (NEWS-A), a validated measure of perceived built environment developed in the USA for adults. A secondary study aim was to establish the generalizability of the NEWS-A to an Asian high-density urban context and a different age group.
Methods
A multidisciplinary panel of experts adapted the original NEWS-A to reflect the built environment of Hong Kong and needs of seniors. The translated instrument was pre-tested on a sample of 50 Chinese-speaking senior residents (65+ years). The final version of the NEWS-CS was interviewer-administered to 484 seniors residing in four selected Hong Kong districts varying in walkability and socio-economic status. Ninety-two participants completed the questionnaire on two separate occasions, 2-3 weeks apart. Test-rest reliability indices were estimated for each item and subscale of the NEWS-CS. Confirmatory factor analysis was used to develop the measurement model of the NEWS-CS and cross-validate that of the NEWS-A.
Results
The final version of the NEWS-CS consisted of 14 subscales and four single items (76 items). Test-retest reliability was moderate to good (ICC > 50 or % agreement > 60) except for four items measuring distance to destinations. The originally-proposed measurement models of the NEWS-A and NEWS-CS required 2-3 theoretically-justifiable modifications to fit the data well.
Conclusions
The NEWS-CS possesses sufficient levels of reliability and factorial validity to be used for measuring perceived neighborhood environment in Chinese seniors. Further work is needed to assess its construct validity and generalizability to other Asian locations. In general, the measurement model of the original NEWS-A was generalizable to this study context, supporting the feasibility of cross-country and age-group comparisons of the effect of the neighborhood environment on walking using the NEWS-A as a tool to measure the perceived built environment.
doi:10.1186/1479-5868-7-84
PMCID: PMC2999582  PMID: 21108800
5.  Distance to parks and non-residential destinations influences physical activity of older people, but crime doesn’t: a cross-sectional study in a southern European city 
BMC Public Health  2015;15:593.
Background
Physical activity (PA) has numerous health benefits, but older adults live mostly sedentary lifestyles. The physical and social neighborhood environment may encourage/dissuade PA. In particular, neighborhood crime may lead to feeling unsafe and affect older adults’ willingness to be physically active. Yet, research on this topic is still inconclusive. Older population, probably the age group most influenced by the neighborhood environment, has been understudied, especially in Southern Europe. In this study, we aimed to analyze the association between leisure-time physical activity (LTPA) in older adults and objective crime, alongside other neighborhood characteristics.
Methods
We obtained data from a population-based cohort from Porto (2005–2008) to assess LTPA. Only adults aged 65 years or more were included (n = 532). A Geographic Information System was used to measure neighborhood characteristics. Neighborhood crime was expressed as crime rates by category (incivilities, criminal offenses with and without violence and traffic crime). Neighborhood characteristics such as socioeconomic deprivation, land gradient, street density, transportation network, distance to parks, non-residential destinations and sport spaces were also included. Generalized Additive Models were fitted to estimate the association between neighborhood characteristics and the participation (being active vs. inactive) and frequency (min/day) of LTPA.
Results
Forty-six percent of the men and 61 % of the women did not engage in any kind of LTPA. Among the active participants, men spent on average 50.5 (35.2 Standard Deviation, SD) min/day in LTPA, whereas the average among women was 36.9 (35.1 SD) min/day (p < 0.001).
Neighborhood crime was unrelated to the participation in, or frequency of, LTPA. On the other hand, two neighborhood characteristics – distance to the nearest park (β = −0.0262, p = 0.029) and to the nearest non-residential destination (β = −0.0735, p = 0.019) – were associated with time spent on LTPA, but only among active older women. No neighborhood characteristic was related to participation in LTPA.
Conclusions
From a public health point of view, the provision of parks and non-residential destinations (shops, schools, cultural and worship places) might contribute to elevate PA levels of already active older women. On the other hand, in this setting, crime was not a big issue.
Electronic supplementary material
The online version of this article (doi:10.1186/s12889-015-1879-y) contains supplementary material, which is available to authorized users.
doi:10.1186/s12889-015-1879-y
PMCID: PMC4483219  PMID: 26116071
Physical activity; Safety; Older adults; Parks; Destinations
6.  Measuring walking within and outside the neighborhood in Chinese elders: reliability and validity 
BMC Public Health  2011;11:851.
Background
Walking is a preferred, prevalent and recommended activity for aging populations and is influenced by the neighborhood built environment. To study this influence it is necessary to differentiate whether walking occurs within or outside of the neighborhood. The Neighborhood Physical Activity Questionnaire (NPAQ) collects information on setting-specific physical activity, including walking, inside and outside one's neighborhood. While the NPAQ has shown to be a reliable measure in adults, its reliability in older adults is unknown. Additionally its validity and the influence of type of neighborhood on reliability and validity have yet to be explored.
Methods
The NPAQ walking component was adapted for Chinese speaking elders (NWQ-CS). Ninety-six Chinese elders, stratified by social economic status and neighborhood walkability, wore an accelerometer and completed a log of walks for 7 days. Following the collection of valid data the NWQ-CS was interviewer-administered. Fourteen to 20 days (average of 17 days) later the NWQ-CS was re-administered. Test-retest reliability and validity of the NWQ-CS were assessed.
Results
Reliability and validity estimates did not differ with type of neighborhood. NWQ-CS measures of walking showed moderate to excellent reliability. Reliability was generally higher for estimates of weekly frequency than minutes of walking. Total weekly minutes of walking were moderately related to all accelerometry measures. Moderate-to-strong associations were found between the NWQ-CS and log-of-walks variables. The NWQ-CS yielded statistically significantly lower mean values of total walking, weekly minutes of walking for transportation and weekly frequency of walking for transportation outside the neighborhood than the log-of-walks.
Conclusions
The NWQ-CS showed measurement invariance across types of neighborhoods. It is a valid measure of walking for recreation and frequency of walking for transport. However, it may systematically underestimate the duration of walking for transport in samples that engage in high levels of this type of walking.
doi:10.1186/1471-2458-11-851
PMCID: PMC3231973  PMID: 22070768
7.  Residential self-selection bias in the estimation of built environment effects on physical activity between adolescence and young adulthood 
Background
Built environment research is dominated by cross-sectional designs, which are particularly vulnerable to residential self-selection bias resulting from health-related attitudes, neighborhood preferences, or other unmeasured characteristics related to both neighborhood choice and health-related outcomes.
Methods
We used cohort data from the National Longitudinal Study of Adolescent Health (United States; Wave I, 1994-95; Wave III, 2001-02; n = 12,701) and a time-varying geographic information system. Longitudinal relationships between moderate to vigorous physical activity (MVPA) bouts and built and socioeconomic environment measures (landcover diversity, pay and public physical activity facilities per 10,000 population, street connectivity, median household income, and crime rate) from adolescence to young adulthood were estimated using random effects models (biased by unmeasured confounders) and fixed effects models (within-person estimator, which adjusts for unmeasured confounders that are stable over time).
Results
Random effects models yielded null associations except for negative crime-MVPA associations [coefficient (95% CI): -0.056 (-0.083, -0.029) in males, -0.061 (-0.090, -0.033) in females]. After controlling for measured and time invariant unmeasured characteristics using within-person estimators, MVPA was higher with greater physical activity pay facilities in males [coefficient (95% CI): 0.024 (0.006, 0.042)], and lower with higher crime rates in males [coefficient (95% CI): -0.107 (-0.140, -0.075)] and females [coefficient (95% CI): -0.046 (-0.083, -0.009)]. Other associations were null or in the counter-intuitive direction.
Conclusions
Comparison of within-person estimates to estimates unadjusted for unmeasured characteristics suggest that residential self-selection can bias associations toward the null, as opposed to its typical characterization as a positive confounder. Differential environment-MVPA associations by residential relocation suggest that studies examining changes following residential relocation may be vulnerable to selection bias. The authors discuss complexities of adjusting for residential self-selection and residential relocation, particularly during the adolescent to young adult transition.
doi:10.1186/1479-5868-7-70
PMCID: PMC2959083  PMID: 20920341
8.  The associations between objectively-determined and self-reported urban form characteristics and neighborhood-based walking in adults 
Background
Self-reported and objectively-determined neighborhood built characteristics are associated with physical activity, yet little is known about their combined influence on walking. This study: 1) compared self-reported measures of the neighborhood built environment between objectively-determined low, medium, and high walkable neighborhoods; 2) estimated the relative associations between self-reported and objectively-determined neighborhood characteristics and walking and; 3) examined the extent to which the objectively-determined built environment moderates the association between self-reported measures of the neighborhood built environment and walking.
Methods
A random cross-section of 1875 Canadian adults completed a telephone-interview and postal questionnaire capturing neighborhood walkability, neighborhood-based walking, socio-demographic characteristics, walking attitudes, and residential self-selection. Walkability of each respondent’s neighborhood was objectively-determined (low [LW], medium [MW], and high walkable [HW]). Covariate-adjusted regression models estimated the associations between weekly participation and duration in transportation and recreational walking and self-reported and objectively-determined walkability.
Results
Compared with objectively-determined LW neighborhoods, respondents in HW neighborhoods positively perceived access to services, street connectivity, pedestrian infrastructure, and utilitarian and recreation destination mix, but negatively perceived motor vehicle traffic and crime related safety. Compared with residents of objectively-determined LW neighborhoods, residents of HW neighborhoods were more likely (p < .05) to participate in (odds ratio [OR] = 3.06), and spend more time, per week (193 min/wk) transportation walking. Perceived access to services, street connectivity, motor vehicle safety, and mix of recreational destinations were also significantly associated with transportation walking. With regard to interactions, HW x utilitarian destination mix was positively associated with participation, HW x physical barriers and MW x pedestrian infrastructure were positively associated with minutes, and HW x safety from crime was negatively associated with minutes, of transportation walking. Neither neighborhood type nor its interactions with perceived measures of walkability were associated with recreational walking, although perceived aesthetics was associated with participation (OR = 1.18, p < .05).
Conclusions
Objectively-determined and self-reported built characteristics are associated with neighborhood-based transportation walking. The objectively-determined built environment might moderate associations between perceptions of walkability and neighborhood-based transportation walking. Interventions that target perceptions in addition to modifications to the neighborhood built environment could result in increases in physical activity among adults.
doi:10.1186/1479-5868-11-71
PMCID: PMC4049386  PMID: 24893719
9.  Cross-validation of the factorial structure of the Neighborhood Environment Walkability Scale (NEWS) and its abbreviated form (NEWS-A) 
Background
The Neighborhood Environment Walkability Scale (NEWS) and its abbreviated form (NEWS-A) assess perceived environmental attributes believed to influence physical activity. A multilevel confirmatory factor analysis (MCFA) conducted on a sample from Seattle, WA showed that, at the respondent level, the factor-analyzable items of the NEWS and NEWS-A measured 11 and 10 constructs of perceived neighborhood environment, respectively. At the census blockgroup (used by the US Census Bureau as a subunit of census tracts) level, the MCFA yielded five factors for both NEWS and NEWS-A. The aim of this study was to cross-validate the individual- and blockgroup-level measurement models of the NEWS and NEWS-A in a geographical location and population different from those used in the original validation study.
Methods
A sample of 912 adults was recruited from 16 selected neighborhoods (116 census blockgroups) in the Baltimore, MD region. Neighborhoods were stratified according to their socio-economic status and transport-related walkability level measured using Geographic Information Systems. Participants self-completed the NEWS. MCFA was used to cross-validate the individual- and blockgroup-level measurement models of the NEWS and NEWS-A.
Results
The data provided sufficient support for the factorial validity of the original individual-level measurement models, which consisted of 11 (NEWS) and 10 (NEWS-A) correlated factors. The original blockgroup-level measurement model of the NEWS and NEWS-A showed poor fit to the data and required substantial modifications. These included the combining of aspects of building aesthetics with safety from crime into one factor; the separation of natural aesthetics and building aesthetics into two factors; and for the NEWS-A, the separation of presence of sidewalks/walking routes from other infrastructure for walking.
Conclusion
This study provided support for the generalizability of the individual-level measurement models of the NEWS and NEWS-A to different urban geographical locations in the USA. It is recommended that the NEWS and NEWS-A be scored according to their individual-level measurement models, which are relatively stable and correspond to constructs commonly used in the urban planning and transportation fields. However, prior to using these instruments in international and multi-cultural studies, further validation work across diverse non-English speaking countries and populations is needed.
doi:10.1186/1479-5868-6-32
PMCID: PMC2700069  PMID: 19508724
10.  Sociodemographic Moderators of Relations of Neighborhood Safety to Physical Activity 
Purpose
To investigate gender, race/ethnicity, education and income as moderators of relations of perceived neighborhood crime, pedestrian, and traffic safety to physical activity.
Methods
Participants were from two samples: adults (N=2199, ages 25–65 years) and older adults (N=718, ages 66+ years) from high- and low-walkable neighborhoods in the Washington, DC and Seattle, WA areas. Neighborhood safety and transportation and leisure walking were assessed via survey, and moderate-vigorous physical activity (MVPA) was assessed using accelerometers. Sociodemographic moderators were investigated using interaction terms and follow-up within-group tests from mixed-effects regression models.
Results
Overall direct effects of safety on physical activity were not found, with one exception. Seven interactions were found in each sample. Interactions were found for all physical activity outcomes, though total MVPA was involved in more interactions in adults than older adults. Half of the interactions revealed significant positive relations of pedestrian and traffic safety to physical activity in the more affluent/advantaged group (i.e., high-education, high-income, White non-Hispanic) and null associations in the less affluent/advantaged group. Race/ethnicity was a moderator only in older adults. One third of the interactions involved gender; half of these involved crime safety. Interactions involving crime safety showed nonsignificant positive trends in the more affluent/advantaged group and women, and nonsignificant negative trends in the less affluent/advantaged group and men.
Conclusion
Sociodemographic moderators of neighborhood safety explained some of the variation in adults' and older adults' physical activity. Patterns suggested positive associations between safety and physical activity in participants with more affluent/advantaged sociodemographic characteristics, though some patterns were inconsistent, particularly for gender. More refined conceptualizations and measures of safety are needed to understand if and how these constructs influence physical activity.
doi:10.1249/MSS.0000000000000274
PMCID: PMC4101912  PMID: 25029166
built environment; crime; gender; race/ethnicity; socioeconomic status; traffic; walking
11.  Built environment and active play among Washington DC metropolitan children: A protocol for a cross-sectional study 
Archives of Public Health  2015;73(1):22.
Background
Research has demonstrated that children who participate in active play are more likely to be physically active, thereby improving long-term health outcomes. Many adult studies have also shown that neighborhood built environments can encourage or discourage routine physical activity. Limited evidence has demonstrated that children who reside in neighborhoods with a built environment that is more inviting to active play exhibit lower overweight and obesity rates as well as an overall better state of well-being. This Built Environment and Active Play (BEAP) Study aims to develop a neighborhood playability rating system in the Washington, DC (DMV) area. Similar to walkability scores, these playability scores will estimate how affable a neighborhood is to active play. The BEAP Study will attempt to provide a broad view of factors influencing the level and type of active play among children.
Methods/Design
Using a cross-sectional design, the BEAP Study will collect data using a mail questionnaire administered to the parents and/or guardians of 2000 children aged 7-12 years residing in select DMV areas in October of 2014. Questionnaire data, including information on active play, home and neighborhood characteristics, parental perceptions, and sociodemographic characteristics will be merged through a geographic information system (GIS) with objective built environment measures in the participants’ neighborhoods. An ordered logit model will be used to regress an ordinal active play outcome on built environment exposure variables while adjusting for potential confounders. Upon the construction of the final model, predictor coefficients will be used as parameters in the scoring system to develop neighborhood playability scores.
Discussion
The BEAP Study intends to generate a neighborhood playability index by characterizing and quantifying children’s active play using parent-reported physical activity data in children, GIS data and built environment measures in participant neighborhoods. The BEAP Study will improve our understanding of the built environment and childhood playability relationship while also contributing to the body of evidence-based built environment and physical activity research.
Electronic supplementary material
The online version of this article (doi:10.1186/s13690-015-0070-3) contains supplementary material, which is available to authorized users.
doi:10.1186/s13690-015-0070-3
PMCID: PMC4436840  PMID: 25992286
Playability; BEAP Study; Built environment; Active play; Physical activity
12.  Is the relationship between the built environment and physical activity moderated by perceptions of crime and safety? 
Background
Direct relationships between safety concerns and physical activity have been inconsistently patterned in the literature. To tease out these relationships, crime, pedestrian, and traffic safety were examined as moderators of built environment associations with physical activity.
Methods
Exploratory analyses used two cross-sectional studies of 2068 adults ages 20–65 and 718 seniors ages 66+ with similar designs and measures. The studies were conducted in the Baltimore, Maryland-Washington, DC and Seattle-King County, Washington regions during 2001–2005 (adults) and 2005–2008 (seniors). Participants were recruited from areas selected to sample high- and low- income and walkability. Independent variables perceived crime, traffic, and pedestrian safety were measured using scales from validated instruments. A GIS-based walkability index was calculated for a street-network buffer around each participant’s home address. Outcomes were total physical activity measured using accelerometers and transportation and leisure walking measured with validated self-reports (IPAQ-long). Mixed effects regression models were conducted separately for each sample.
Results
Of 36 interactions evaluated across both studies, only 5 were significant (p < .05). Significant interactions did not consistently support a pattern of highest physical activity when safety was rated high and environments were favorable. There was not consistent evidence that safety concerns reduced the beneficial effects of favorable environments on physical activity. Only pedestrian safety showed evidence of a consistent main effect with physical activity outcomes, possibly because pedestrian safety items (e.g., crosswalks, sidewalks) were not as subjective as those on the crime and traffic safety scales.
Conclusions
Clear relationships between crime, pedestrian, and traffic safety with physical activity levels remain elusive. The development of more precise safety variables and the use of neighborhood-specific physical activity outcomes may help to elucidate these relationships.
doi:10.1186/1479-5868-11-24
PMCID: PMC3942774  PMID: 24564971
Ecological models; Older adults; Parks; Social environment; Walkability; Traffic; Transportation
13.  Reliability of self-reported neighborhood characteristics 
The majority of studies examining the relation between neighborhood environments and health have used census-based indicators to characterize neighborhoods. These studies have shown that neighborhood socieconomic characteristics are associated with a range of health outcomes. Establishing if these associations reflect causal relations requires testing hypotheses regarding how specific features of neighborhoods are related to specific health outcomes. However, there is little information on the reliability of neighborhood measures. The purpose of this study was to estimate the reliability of a questionnaire measuring various self-reported measures of the neighborhood environment of possible relevance to cardiovascular disease. The study consisted of a faceto-face and telephone interview administered twice to 48 participants over a 2-week period. The face-to-face and telephone portions of the interview lasted an average of 5 and 11 minutes, respectively. The questionnaire was piloted among a largely Latino and African American study sample recruited from a public hospital setting in New York City. Scales were used to assess six neighborhood domains: aesthetic quality, walking/ exercise environment, safety from crime, violence, access to healthy foods, and social cohesion. Cronbach’s α’s ranged from. 77 to. 94 for the scales corresponding to these domains, with test-retest correlations ranging from 0.78 to 0.91. In addition neighborhood indices for presence of recreational facilities, quality of recreational facilities, neighborhood participation, and neighborhood problems were examined. Test-retest reliability measures for these indices ranged from 0.73 to 0.91. The results from this study suggested that self-reported neighborhood characteristics can be reliably measured.
doi:10.1093/jurban/jth151
PMCID: PMC3455923  PMID: 15466849
Cardiovascular disease; Neighborhoods; Pathways; Reliability; Self-report
14.  Perceptions of Neighborhood Disorder: The Role of Individual and Neighborhood Characteristics 
Social science quarterly  2009;90(5):1298-1320.
Objectives
The study of neighborhood effects on health and wellbeing has regained prominence in recent years. Most authors have relied on Census data and other administrative data sources to assess neighborhood characteristics. Less commonly employed, but gaining in popularity, are measures from surveys which ask neighborhood residents about various aspects of their neighborhood environment. Such surveys are a potentially attractive alternative or augmentation to administrative data sources.
Methods
Using data from a study of neighborhood effects on pregnancy outcomes among low income, inner city women in Philadelphia, PA (N=3,988), we examined psychometric and ecometric properties of scales used to assess perceptions of crime and safety, physical disorder and social disorder, and estimated effects of individual and neighborhood level predictors on perceptions.
Results
The three perceived neighborhood disorder scales had high internal consistency and good neighborhood level reliability. Several individual attributes of the women predicted perceptions of neighborhood disorder controlling for neighborhood level characteristics (within census tract, fixed-effect estimates). In addition, our objective indicators of neighborhood crime, physical and social disorder were highly significant predictors of women's perceptions, explaining over 70% of the between neighborhood variation in perceptions.
Conclusions
When data on objective neighborhood characteristics are unavailable the inclusion of questions about residents' perceptions of neighborhood conditions in surveys of inner city residents provides a useful alternative to characterize neighborhood conditions.
doi:10.1111/j.1540-6237.2009.00657.x
PMCID: PMC2822409  PMID: 20174462
15.  The short international physical activity questionnaire: cross-cultural adaptation, validation and reliability of the Hausa language version in Nigeria 
Background
Accurate assessment of physical activity is important in determining the risk for chronic diseases such as cardiovascular disease, stroke, type 2 diabetes, cancer and obesity. The absence of culturally relevant measures in indigenous languages could pose challenges to epidemiological studies on physical activity in developing countries. The purpose of this study was to translate and cross-culturally adapt the Short International Physical Activity Questionnaire (IPAQ-SF) to the Hausa language, and to evaluate the validity and reliability of the Hausa version of IPAQ-SF in Nigeria.
Methods
The English IPAQ-SF was translated into the Hausa language, synthesized, back translated, and subsequently subjected to expert committee review and pre-testing. The final product (Hausa IPAQ-SF) was tested in a cross-sectional study for concurrent (correlation with the English version) and construct validity, and test-retest reliability in a sample of 102 apparently healthy adults.
Results
The Hausa IPAQ-SF has good concurrent validity with Spearman correlation coefficients (ρ) ranging from 0.78 for vigorous activity (Min Week-1) to 0.92 for total physical activity (Metabolic Equivalent of Task [MET]-Min Week-1), but poor construct validity, with cardiorespiratory fitness (ρ = 0.21, p = 0.01) and body mass index (ρ = 0.22, p = 0.04) significantly correlated with only moderate activity and sitting time (Min Week-1), respectively. Reliability was good for vigorous (ICC = 0.73, 95% C.I = 0.55-0.84) and total physical activity (ICC = 0.61, 95% C.I = 0.47-0.72), but fair for moderate activity (ICC = 0.33, 95% C.I = 0.12-0.51), and few meaningful differences were found in the gender and socioeconomic status specific analyses.
Conclusions
The Hausa IPAQ-SF has acceptable concurrent validity and test-retest reliability for vigorous-intensity activity, walking, sitting and total physical activity, but demonstrated only fair construct validity for moderate and sitting activities. The Hausa IPAQ-SF can be used for physical activity measurements in Nigeria, but further construct validity testing with objective measures such as an accelerometer is needed.
doi:10.1186/1471-2288-11-156
PMCID: PMC3233518  PMID: 22108455
16.  Can Virtual Streetscape Audits Reliably Replace Physical Streetscape Audits? 
There is increasing recognition that the neighborhood-built environment influences health outcomes, such as physical activity behaviors, and technological advancements now provide opportunities to examine the neighborhood streetscape remotely. Accordingly, the aims of this methodological study are to: (1) compare the efficiencies of physically and virtually conducting a streetscape audit within the neighborhood context, and (2) assess the level of agreement between the physical (criterion) and virtual (test) audits. Built environment attributes associated with walking and cycling were audited using the New Zealand Systematic Pedestrian and Cycling Environment Scan (NZ-SPACES) in 48 street segments drawn from four neighborhoods in Auckland, New Zealand. Audits were conducted physically (on-site) and remotely (using Google Street View) in January and February 2010. Time taken to complete the audits, travel mileage, and Internet bandwidth used were also measured. It was quicker to conduct the virtual audits when compared with the physical audits (χ = 115.3 min (virtual), χ = 148.5 min (physical)). In the majority of cases, the physical and virtual audits were within the acceptable levels of agreement (ICC ≥ 0.70) for the variables being assessed. The methodological implication of this study is that Google Street View is a potentially valuable data source for measuring the contextual features of neighborhood streets that likely impact on health outcomes. Overall, Google Street View provided a resource-efficient and reliable alternative to physically auditing the attributes of neighborhood streetscapes associated with walking and cycling. Supplementary data derived from other sources (e.g., Geographical Information Systems) could be used to assess the less reliable streetscape variables.
doi:10.1007/s11524-010-9505-x
PMCID: PMC3005090  PMID: 21104331
Cycling; Google street view; Neighborhood; SPACES; Walking
17.  Linking Places to Problems: Geospatial Theories of Neighborhoods, Alcohol and Crime 
GeoJournal  2011;78(3):417-428.
This paper provides a critical review of two broad categories of social ecological theories of crime, social integration and place-based theories, and their relationships to spatial assessments of crime patterns. Social integration theories emphasize the role of neighborhood disorganization on crime, while place theories stress the social interactions within and between places as a source of crime. We provide an analysis of the extent to which these two types of theorizing describe processes and mechanisms that are truly ecologic (identify specific interactions between individuals and their environments) and truly spatial (identify specific movement and interaction patterns of individuals and groups) as they endeavor to explain crime outcomes. We suggest that social integration theories do not provide spatial signatures of sufficient specificity to justify the application of spatial statistical techniques as quantitative arbiters of the theory. On the other hand, place based theories go some way toward addressing these issues because the emphasis is placed on understanding the exact physical and social characteristics of place and the activities that occur around locations as sources of crime. Routine activities and crime potential theories attempt to explain clustering or “hot spots” of crime in ways that give clear spatial dimension by looking at micro-spatial interactions between offenders and targets of crime. These theories have strong ecological implications as well, since they contain specific statements about how people use the space around them and how these patterns of use are related to patterns of criminal activity. We conclude by identifying a set of requirements for successful empirical tests of geospatial theories, including the development of valid measures of key theoretical constructs and the formulation of critical empirical assessments of geospatial hypotheses derived from motivating theory.
doi:10.1007/s10708-011-9425-7
PMCID: PMC3673749  PMID: 23750067
18.  Objective assessment of urban built environment related to physical activity — development, reliability and validity of the China Urban Built Environment Scan Tool (CUBEST) 
BMC Public Health  2014;14:109.
Background
Some aspects of the neighborhood built environment may influence residents’ physical activity, which in turn, affects their health. This study aimed to develop an urban built environment evaluation tool and conduct necessary reliability and validity tests.
Methods
A 41-item urban built environment scan tool was developed to objectively assess the neighborhood built environment features related to physical activity. Six neighborhoods in Hangzhou were selected from three types of administrative planning units. A pair of auditors independently assessed all of the 205 street segments at the same time. Half of the segments (n = 104) were audited twice by the same auditor after a two-week time interval. Inter-rater reliability was assessed by comparing the audits of paired observers, while intra-rater reliability was evaluated by comparing an auditor’s repeated assessments of the same segments. The construct validity was tested using factor analysis.
Results
The inter-rater reliability for most items was above 0.8. The intra-rater reliability for most items was above 0.4, and was lower than corresponding inter-rater reliability. Six factors were extracted by factor analysis and the factor loading matrix showed good construct validity.
Conclusions
The CUBEST is a reliable and valid instrument that can be used to assess the physical activity-related built environment in Hangzhou, and potentially other cities in China.
doi:10.1186/1471-2458-14-109
PMCID: PMC3916581  PMID: 24495676
Environmental scan; Physical activity; Reliability; Validity
19.  Girls' perception of physical environmental factors and transportation: reliability and association with physical activity and active transport to school 
Background
Preliminary evidence suggests that the physical environment and transportation are associated with youth physical activity levels. Only a few studies have examined the association of physical environmental factors on walking and bicycling to school. Therefore, the purpose of this study was (1) to examine the test-retest reliability of a survey designed for youth to assess perceptions of physical environmental factors (e.g. safety, aesthetics, facilities near the home) and transportation, and (2) to describe the associations of these perceptions with both physical activity and active transport to school.
Methods
Test and retest surveys, administered a median of 12 days later, were conducted with 480 sixth- and eighth-grade girls in or near six U.S. communities. The instrument consisted of 24 questions on safety and aesthetics of the perceived environment and transportation and related facilities. Additionally, girls were asked if they were aware of 14 different recreational facilities offering structured and unstructured activities, and if so, whether they would visit these facilities and the ease with which they could access them. Test-retest reliability was determined using kappa coefficients, overall and separately by grade. Associations with physical activity and active transport to school were examined using mixed model logistic regression (n = 610), adjusting for grade, race/ethnicity, and site.
Results
Item-specific reliabilities for questions assessing perceived safety and aesthetics of the neighborhood ranged from 0.31 to 0.52. Reliabilities of items assessing awareness of and interest in going to the 14 recreational facilities ranged from 0.47 to 0.64. Reliabilities of items assessing transportation ranged from 0.34 to 0.58. Some items on girls' perceptions of perceived safety, aesthetics of the environment, facilities, and transportation were important correlates of physical activity and, in some cases, active transport to school.
Conclusion
This study provides some psychometric support for the use of the questionnaire on physical environmental factors and transportation for studying physical activity and active transport to school among adolescent girls. Further work can continue to improve reliability of these self-report items and examine their association of these factors with objectively measured physical activity.
doi:10.1186/1479-5868-3-28
PMCID: PMC1594571  PMID: 16972999
20.  Disentangling neighborhood contextual associations with child body mass index, diet, and physical activity: The role of built, socioeconomic, and social environments 
Obesity prevalence among US children and adolescents has tripled in the past three decades. Consequently, dramatic increases in chronic disease incidence are expected, particularly among populations already experiencing health disparities. Recent evidence identifies characteristics of “obesogenic” neighborhood environments that affect weight and weight-related behaviors. This study aimed to examine associations between built, socioeconomic, and social characteristics of a child’s residential environment on body mass index (BMI), diet, and physical activity. We focused on pre-adolescent children living in New Haven, Connecticut to better understand neighborhood environments’ contribution to persistent health disparities. Participants were 1048 fifth and sixth grade students who completed school-based health surveys and physical measures in fall 2009. Student data were linked to US Census, parks, retailer, and crime data. Analyses were conducted using multilevel modeling. Property crimes and living further from a grocery store were associated with higher BMI. Students living within a 5-min walk of a fast food outlet had higher BMI, and those living in a tract with higher density of fast food outlets reported less frequent healthy eating and more frequent unhealthy eating. Students’ reported perceptions of access to parks, playgrounds, and gyms were associated with more frequent healthy eating and exercise. Students living in more affluent neighborhoods reported more frequent healthy eating, less unhealthy eating, and less screen time. Neighborhood social ties were positively associated with frequency of exercise. In conclusion, distinct domains of neighborhood environment characteristics were independently related to children’s BMI and health behaviors. Findings link healthy behaviors with built, social, and socioeconomic environment assets (access to parks, social ties, affluence), and unhealthy behaviors with built environment inhibitors (access to fast food outlets), suggesting neighborhood environments are an important level at which to intervene to prevent childhood obesity and its adverse consequences.
doi:10.1016/j.socscimed.2013.04.003
PMCID: PMC4058500  PMID: 23642646
New Haven, Connecticut, USA; Health behaviors; Neighborhood; Built environment; Socioeconomic status; Social environment; Health disparities
21.  Identification of contrastive and comparable school neighborhoods for childhood obesity and physical activity research 
The neighborhood social and physical environments are considered significant factors contributing to children's inactive lifestyles, poor eating habits, and high levels of childhood obesity. Understanding of neighborhood environmental profiles is needed to facilitate community-based research and the development and implementation of community prevention and intervention programs. We sought to identify contrastive and comparable districts for childhood obesity and physical activity research studies.
We have applied GIS technology to manipulate multiple data sources to generate objective and quantitative measures of school neighborhood-level characteristics for school-based studies. GIS technology integrated data from multiple sources (land use, traffic, crime, and census tract) and available social and built environment indicators theorized to be associated with childhood obesity and physical activity. We used network analysis and geoprocessing tools within a GIS environment to integrate these data and to generate objective social and physical environment measures for school districts. We applied hierarchical cluster analysis to categorize school district groups according to their neighborhood characteristics. We tested the utility of the area characterizations by using them to select comparable and contrastive schools for two specific studies.
Results
We generated school neighborhood-level social and built environment indicators for all 412 Chicago public elementary school districts. The combination of GIS and cluster analysis allowed us to identify eight school neighborhoods that were contrastive and comparable on parameters of interest (land use and safety) for a childhood obesity and physical activity study.
Conclusion
The combination of GIS and cluster analysis makes it possible to objectively characterize urban neighborhoods and to select comparable and/or contrasting neighborhoods for community-based health studies.
doi:10.1186/1476-072X-5-14
PMCID: PMC1526711  PMID: 16573835
22.  Perceived neighborhood safety and incident mobility disability among elders: the hazards of poverty 
BMC Public Health  2009;9:162.
Background
We investigated whether lack of perceived neighborhood safety due to crime, or living in high crime neighborhoods was associated with incident mobility disability in elderly populations. We hypothesized that low-income elders and elders at retirement age (65 – 74) would be at greatest risk of mobility disability onset in the face of perceived or measured crime-related safety hazards.
Methods
We conducted the study in the New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE), a longitudinal cohort study of community-dwelling elders aged 65 and older who were residents of New Haven, Connecticut in 1982. Elders were interviewed beginning in 1982 to assess mobility (ability to climb stairs and walk a half mile), perceptions of their neighborhood safety due to crime, annual household income, lifestyle characteristics (smoking, alcohol use, physical activity), and the presence of chronic co-morbid conditions. Additionally, we collected baseline data on neighborhood crime events from the New Haven Register newspaper in 1982 to measure local area crime rates at the census tract level.
Results
At baseline in 1982, 1,884 elders were without mobility disability. After 8 years of follow-up, perceiving safety hazards was associated with increased risk of mobility disability among elders at retirement age whose incomes were below the federal poverty line (HR 1.56, 95% CI 1.02 – 2.37). No effect of perceived safety hazards was found among elders at retirement age whose incomes were above the poverty line. No effect of living in neighborhoods with high crime rates (measured by newspaper reports) was found in any sub-group.
Conclusion
Perceiving a safety hazard due to neighborhood crime was associated with increased risk of incident mobility disability among impoverished elders near retirement age. Consistent with prior literature, retirement age appears to be a vulnerable period with respect to the effect of neighborhood conditions on elder health. Community violence prevention activities should address perceived safety among vulnerable populations, such as low-income elders at retirement age, to reduce future risks of mobility disability.
doi:10.1186/1471-2458-9-162
PMCID: PMC2693137  PMID: 19476610
23.  Perceived characteristics of the environment associated with active travel: development and testing of a new scale 
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.
doi:10.1186/1479-5868-5-32
PMCID: PMC2416440  PMID: 18513430
24.  Concepts Guiding the Study of the Impact of the Built Environment on Physical Activity for Older Adults: A Review of the Literature 
Objective
To identify theoretical models and key concepts used to predict the association between built environment and seniors’ physical activity on the basis of a comprehensive review of the published literature.
Data Source
Computer searches of Medline (1966–2002), PubMed (1966–2002), and Academic Search Elite (1966–2002) were conducted, and 27 English-language articles were found. Search terms included built environment, physical activity, exercise, walking, neighborhood, urban design, seniors, aging, aging in place, and physical environment.
Study Inclusion and Exclusion Criteria
The primary inclusion criterion included the relation between the built environment and the physical activity among seniors living in neighborhoods. Studies assessing physical activity or overall health of a community-based population were included if underlying theoretical models and concepts were applicable to a senior population. Studies solely assessing social or psychosocial characteristics of place were excluded, as were review articles.
Data Extraction
Extracted data included theoretical model, aspect of built environment studied, methods, and outcomes.
Data Synthesis
Tables present key definitions and summarize information from empirical studies.
Results
Twenty-seven articles that focused on the environment-behavior relation in neighborhoods, six specific to seniors, were found. This area of research is in its infancy, and inconsistent findings reflect difficulties in measurement of the built environment.
Conclusions
The relation between the built environment and the physical activity among seniors has been the subject of a limited number of studies. The choice of theoretical model drives the selection of concepts and variables considered. Safety, microscale urban design elements, aesthetics, and convenience of facilities are consistently studied across models. Few validated instruments have been developed and tested to measure neighborhood built environment.
PMCID: PMC3115687  PMID: 15293929
Built Environment; Seniors; Walking; Physical Activity
25.  Correlates of Walking for Transportation and Use of Public Transportation Among Adults in St Louis, Missouri, 2012 
Introduction
Attributes of the built environment can influence active transportation, including use of public transportation. However, the relationship between perceptions of the built environment and use of public transportation deserves further attention. The objectives of this study were 1) to assess the relationship between personal characteristics and public transportation use with meeting national recommendations for moderate physical activity through walking for transportation and 2) to examine associations between personal and perceived environmental factors and frequency of public transportation use.
Methods
In 2012, we administered a mail-based survey to 772 adults in St Louis, Missouri, to assess perceptions of the built environment, physical activity, and transportation behaviors. The abbreviated International Physical Activity Questionnaire was used to assess walking for transportation and use of public transportation. The Neighborhood Environment Walkability Scale was used to examine perceptions of the built environment. Associations were assessed by using multinomial logistic regression.
Results
People who used public transportation at least once in the previous week were more likely to meet moderate physical activity recommendations by walking for transportation. Age and employment were significantly associated with public transportation use. Perceptions of high traffic speed and high crime were negatively associated with public transportation use.
Conclusion
Our results were consistent with previous research suggesting that public transportation use is related to walking for transportation. More importantly, our study suggests that perceptions of traffic speed and crime are related to frequency of public transportation use. Future interventions to encourage public transportation use should consider policy and planning decisions that reduce traffic speed and improve safety.
doi:10.5888/pcd11.140125
PMCID: PMC4082435  PMID: 24995654

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