Measuring the food and built environments in urban centres: reliability and validity of the EURO-PREVOB Community Questionnaire.

OBJECTIVES The authors designed an instrument to measure objectively aspects of the built and food environments in urban areas, the EURO-PREVOB Community Questionnaire, within the EU-funded project 'Tackling the social and economic determinants of nutrition and physical activity for the prevention of obesity across Europe' (EURO-PREVOB). This paper describes its development, reliability, validity, feasibility and relevance to public health and obesity research. STUDY DESIGN The Community Questionnaire is designed to measure key aspects of the food and built environments in urban areas of varying levels of affluence or deprivation, within different countries. The questionnaire assesses (1) the food environment and (2) the built environment. METHODS Pilot tests of the EURO-PREVOB Community Questionnaire were conducted in five to 10 purposively sampled urban areas of different socio-economic status in each of Ankara, Brno, Marseille, Riga, and Sarajevo. Inter-rater reliability was compared between two pairs of fieldworkers in each city centre using three methods: inter-observer agreement (IOA), kappa statistics, and intraclass correlation coefficients (ICCs). RESULTS Data were collected successfully in all five cities. Overall reliability of the EURO-PREVOB Community Questionnaire was excellent (inter-observer agreement (IOA) > 0.87; intraclass correlation coefficients (ICC)s > 0.91 and kappa statistics > 0.7. However, assessment of certain aspects of the quality of the built environment yielded slightly lower IOA coefficients than the quantitative aspects. CONCLUSIONS The EURO-PREVOB Community Questionnaire was found to be a reliable and practical observational tool for measuring differences in community-level data on environmental factors that can impact on dietary intake and physical activity. The next step is to evaluate its predictive power by collecting behavioural and anthropometric data relevant to obesity and its determinants.

[1]  A. D. Diez Roux,et al.  Neighborhood characteristics associated with the location of food stores and food service places. , 2002, American journal of preventive medicine.

[2]  M. Kreuter,et al.  Social environment and physical activity: a review of concepts and evidence. , 2006, Social science & medicine.

[3]  Ann Forsyth,et al.  The Irvine-Minnesota inventory to measure built environments: development. , 2006, American journal of preventive medicine.

[4]  E. Vartiainen,et al.  Age, education and occupation as determinants of trends in body mass index in Finland from 1982 to 1997 , 2000, International Journal of Obesity.

[5]  Martin McKee,et al.  Environmental Profile of a Community's Health (EPOCH): An Instrument to Measure Environmental Determinants of Cardiovascular Health in Five Countries , 2010, PloS one.

[6]  P. Athanasoglou in the South Eastern European region , 2011 .

[7]  Christine M. Hoehner,et al.  Measuring the built environment for physical activity: state of the science. , 2009, American journal of preventive medicine.

[8]  R. Ewing,et al.  The built environment and obesity. , 2007, Epidemiologic reviews.

[9]  Billie Giles-Corti,et al.  Neighborhood environmental factors correlated with walking near home: Using SPACES. , 2006, Medicine and science in sports and exercise.

[10]  Christine M. Hoehner,et al.  Perceived and objective environmental measures and physical activity among urban adults. , 2005, American journal of preventive medicine.

[11]  Philip M. Hurvitz,et al.  Residential property values are associated with obesity among women in King County, WA, USA. , 2012, Social science & medicine.

[12]  A. Drewnowski Obesity, diets, and social inequalities. , 2009, Nutrition reviews.

[13]  C. Pettinger,et al.  'All under one roof?' differences in food availability and shopping patterns in Southern France and Central England. , 2007, European journal of public health.

[14]  Brian Fisher,et al.  Reliability Test of an Established Pedestrian Environment Audit in Rural Settings , 2010, American journal of health promotion : AJHP.

[15]  M. Charles,et al.  [Prevalence of obesity in adults in France: the situation in 2000 established from the OBEPI Study]. , 2002, Annales d'endocrinologie.

[16]  B. Swinburn,et al.  Preventive strategies against weight gain and obesity , 2002, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[17]  T. Lobstein,et al.  Wider income gaps, wider waistbands? An ecological study of obesity and income inequality , 2005, Journal of Epidemiology and Community Health.

[18]  M. Ferrer,et al.  Social inequalities in health among adolescents in a large southern European city , 2009, Journal of Epidemiology & Community Health.

[19]  Marnie Purciel-Hill,et al.  Measuring food deserts in New York City's low-income neighborhoods. , 2011, Health & place.

[20]  Allison Karpyn,et al.  Reestablishing healthy food retail: changing the landscape of food deserts. , 2012, Childhood obesity.

[21]  Steve Wing,et al.  The contextual effect of the local food environment on residents' diets: the atherosclerosis risk in communities study. , 2002, American journal of public health.

[22]  Carol R Horowitz,et al.  Barriers to buying healthy foods for people with diabetes: evidence of environmental disparities. , 2004, American journal of public health.

[23]  B. Popkin,et al.  Environmental influences on food choice, physical activity and energy balance , 2005, Physiology & Behavior.

[24]  James Macinko,et al.  Neighborhoods and obesity. , 2008, Nutrition reviews.

[25]  B. Psaty,et al.  Do communities differ in health behaviors? , 1993, Journal of clinical epidemiology.

[26]  S. Demarest,et al.  Trends in social inequalities in obesity: Belgium, 1997 to 2004. , 2009, Preventive medicine.

[27]  F. Paccaud,et al.  Changes of overweight and obesity in the adult Swiss population according to educational level, from 1992 to 2007 , 2010, BMC public health.

[28]  Lawrence D Frank,et al.  Nutrition Environment Measures Survey in stores (NEMS-S): development and evaluation. , 2007, American journal of preventive medicine.

[29]  E. Dowler Inequalities in diet and physical activity in Europe , 2001, Public Health Nutrition.

[30]  J. Sallis Measuring physical activity environments: a brief history. , 2009, American journal of preventive medicine.

[31]  David Ogilvie,et al.  The 'Walking for Wellbeing in the West' randomised controlled trial of a pedometer-based walking programme in combination with physical activity consultation with 12 month follow-up: rationale and study design , 2008, BMC public health.

[32]  Caitlin E. Caspi,et al.  The relationship between diet and perceived and objective access to supermarkets among low-income housing residents. , 2012, Social science & medicine.

[33]  C. Dias,et al.  Trends in overweight and obesity in Portugal: the National Health Surveys 1995-6 and 1998-9. , 2005, Obesity research.

[34]  Leslie A Lytle,et al.  Measures of the food environment: a compilation of the literature, 1990-2007. , 2009, American journal of preventive medicine.

[35]  Susan L Handy,et al.  Measuring the food and physical activity environments: shaping the research agenda. , 2009, American journal of preventive medicine.

[36]  Karen Glanz,et al.  Measuring food environments: a historical perspective. , 2009, American journal of preventive medicine.

[37]  Michael Sjöström,et al.  Measuring physical activity-related environmental factors: reliability and predictive validity of the European environmental questionnaire ALPHA , 2010, The international journal of behavioral nutrition and physical activity.

[38]  E. Dowler,et al.  Nutrition and poverty in Europe: An overview , 1997, Proceedings of the Nutrition Society.

[39]  B. Swinburn,et al.  Measuring the 'obesogenic' food environment in New Zealand primary schools. , 2004, Health promotion international.

[40]  Sharon Friel,et al.  Closing the gap in a generation: health equity through action on the social determinants of health , 2008, The Lancet.

[41]  A. Gustafson,et al.  Validation of food store environment secondary data source and the role of neighborhood deprivation in Appalachia, Kentucky , 2012, BMC Public Health.

[42]  Martin McKee,et al.  Environmental and societal influences acting on cardiovascular risk factors and disease at a population level: a review. , 2009, International journal of epidemiology.

[43]  B. Swinburn,et al.  Dissecting obesogenic environments: the development and application of a framework for identifying and prioritizing environmental interventions for obesity. , 1999, Preventive medicine.

[44]  J. Sallis,et al.  Neighborhood Environment Walkability Scale: validity and development of a short form. , 2006, Medicine and science in sports and exercise.

[45]  L. Elinder,et al.  Obesogenic environments – aspects on measurement and indicators , 2008, Public Health Nutrition.

[46]  J. L. Gutiérrez-Fisac,et al.  The size of obesity differences associated with educational level in Spain, 1987 and 1995/97 , 2002, Journal of epidemiology and community health.

[47]  J. Mackenbach,et al.  Socioeconomic inequalities in health in 22 European countries. , 2008, The New England journal of medicine.

[48]  B. Giles-Corti,et al.  Socioeconomic status differences in recreational physical activity levels and real and perceived access to a supportive physical environment. , 2002, Preventive medicine.

[49]  A. Robertson Obesity and socio-economic groups in Europe: Evidence review and implications for action , 2007 .

[50]  P. Newby Are Dietary Intakes and Eating Behaviors Related to Childhood Obesity? A Comprehensive Review of the Evidence , 2007, The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics.

[51]  Icf Macro Turkey Demographic and Health Survey 2008 , 2009 .

[52]  G. Turrell,et al.  Socio-economic differences in fruit and vegetable consumption among Australian adolescents and adults , 2002, Public Health Nutrition.

[53]  S. Cummins,et al.  “Food deserts”—evidence and assumption in health policy making , 2002, BMJ : British Medical Journal.

[54]  A. Ellaway,et al.  Does where you live predict health related behaviours?: a case study in Glasgow. , 1996, Health bulletin.

[55]  Ann Forsyth,et al.  The Irvine-Minnesota inventory to measure built environments: reliability tests. , 2006, American journal of preventive medicine.

[56]  G. Turrell,et al.  Socioeconomic differences among Australian adults in consumption of fruit and vegetables and intakes of vitamins A, C and folate. , 2002, Journal of human nutrition and dietetics : the official journal of the British Dietetic Association.

[57]  K. Neckerman,et al.  Built environments and obesity in disadvantaged populations. , 2009, Epidemiologic reviews.

[58]  K. Ball,et al.  Socioeconomic status and weight change in adults: a review. , 2005, Social science & medicine.