American Journal of Preventive Medicine
Measuring the food and physical activity environments: State of the scienceMeasuring the Built Environment for Physical Activity: State of the Science
Introduction
Physical inactivity is one of the most important public health issues in the U.S. and internationally, due to its contribution to premature mortality and economic costs (e.g., medical costs, lost productivity).1, 2, 3 Increasingly, links are being identified between various elements of the physical or built environment and physical activity.4, 5, 6, 7, 8 The built environment—the physical form of communities—includes land-use patterns (how land is used); large- and small-scale built and natural features (e.g., architectural details, quality of landscaping); and the transportation system (the facilities and services that link one location to another).8, 9, 10, 11 Together, these elements shape access to opportunities for physical activity. (In this article, the terms built environment and physical environment are used interchangeably.)
Conceptual models guiding research on built environments and physical activity propose that different domains of physical activity (e.g., leisure, transportation, household) are affected by different environmental attributes.12, 13, 14, 15 Leisure physical activity may be most affected by access to, and characteristics of, public and private recreation facilities.16 Transportation physical activity may be most related to the proximity and directness of routes from home to destinations (known as walkability) as well as characteristics of the walking and cycling infrastructure, including sidewalks, bicycle lanes, and trails.8 Therefore, to understand the influences of the built environment on physical activity, a wide range of environmental measures is needed.
Studies of the built environment and physical activity have evolved over the past few decades. Early research focused on compliance with supervised exercise programs in relation to proximity to facilities.17 The next generation of studies examined the impact of the community environment (especially convenience of facilities) on leisure physical activity in various populations.18, 19, 20 At the same time, transportation and city planning researchers were studying the relationship of land-use patterns to walking and cycling for transportation, using both survey and GIS measures.5, 9, 10 More recently, better measures of the built environment have been developed, and physical activity surveys have become more comprehensive, allowing assessment of specific behaviors such as walking and cycling for both recreational and transportation purposes.21, 22 These measurement advances have allowed research in the past few years to examine multiple elements of the environment in relation to multiple modes and purposes of physical activity.4, 5, 23, 24, 25, 26, 27, 28, 29
To understand the impact of the built environment on physical activity, the development of high-quality measures is essential.30 Three categories of built-environment measures are being used. Obtained by interview or self-administered questionnaires, the first group of measures examines the extent to which individuals perceive access and barriers to various elements of recreation, land use, and transportation environments. The second set of measures uses systematic observations, or audits, to “objectively and unobtrusively”31 quantify attributes of the built environment. A third group of measures involves data from archival (existing) data sets that are often layered and analyzed with GIS. Across all three categories (i.e., surveys, audits, and GIS/archival data) development and evaluation of measurement properties are still at a relatively early stage.
This article provides a description of the state of the science in measuring built-environment attributes believed to be related to physical activity. Instruments were identified through searches of the literature, expert input, and feedback from a 2007 workshop. A critical assessment is provided of perceived measures, observational (audit) approaches, and GIS-derived metrics. Whenever possible, the psychometric properties (i.e., reliability and validity) of measures are described, gaps identified in current science, and recommendations made for future progress. Although the focus is primarily on measures of the physical environment, brief mention is included of other contextual variables that are closely intertwined (e.g., crime, social environment, policy variables).32, 33
Section snippets
Perceived (Self-Reported) Environment Measures
Evidence on the association between the built environment and physical activity behavior is derived mostly from self-report data on individuals' perceptions of their environments.4, 34 More than 100 published studies have examined physical activity behavior in relation to perceptions of the environment. The environment in these studies includes a combination of the physical (built) environment,10, 35 social factors,33, 36 and policy influences.37, 38, 39 In a recent meta-analysis involving 16
Observational Measures (Community Audits)
In addition to perceived-environment measures, researchers have developed instruments and protocols to measure the actual physical environment as it is directly observed.77
Description of Approach
Geographic information systems have much to offer public health researchers interested in the effects of the neighborhood or regional environment on physical activity and obesity. GIS has been defined as the “integration of software, hardware, and data for capturing, storing, analyzing and displaying all forms of geographically referenced information.”100 GIS-based measures as described here simply refer to measures of the built environment derived primarily from existing data sources that have
Challenges and Future Directions
This first comprehensive examination of built-environment measures of relevance to physical activity has demonstrated a great deal of progress over the past decade. Measures of diverse environmental variables are available that use multiple modes of assessment. Most can be considered first-generation measures, so further development is needed. Numerous challenges were identified in three broad categories, and overcoming them will require concerted effort and dedicated funding.
Conclusion
A substantial literature on measurement of the built environment for physical activity now exists. These topics are of importance to both researchers and practitioners.175, 176 Although limitations were identified for all types of measures, existing measures have stimulated rapid advancements in understanding environmental correlates of physical activity in a variety of populations and settings. Numerous challenges remain, such as continually improving measures, ensuring relevance for diverse
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