Abstract
BackgroundPhysical inactivity and unhealthy diet are key behavioral determinants underlying obesity. The neighborhood environment represents an important arena for modifying these behaviors, and hence reliable and valid tools to measure it are needed. Most existing virtual audit tools have been designed to assess either food or activity environments deemed relevant for adults. Thus, there is a need for a tool that combines the assessment of food and activity environments, and which focuses on aspects of the environment relevant for youth.ObjectiveThe aims of the present study were: (a) to adapt the SPOTLIGHT Virtual Audit Tool (S-VAT) developed to assess characteristics of the built environment deemed relevant for adults for use in an adolescent population, (b) to assess the tool’s inter- and intra-rater reliability, and (c) to assess its criterion validity by comparing the virtual audit to a field audit.MethodsThe tool adaptation was based on literature review and on results of a qualitative survey investigating how adolescents perceived the influence of the environment on dietary and physical activity behaviors. Sixty streets (148 street segments) in six neighborhoods were randomly selected as the study sample. Two raters assessed the inter- and intra-rater reliability and criterion validity, comparing the virtual audit tool to a field audit. The results were presented as percentage agreement and Cohen’s kappa (κ).ResultsIntra-rater agreement was found to be moderate to almost perfect (κ = 0.44–0.96) in all categories, except in the category aesthetics (κ = 0.40). Inter-rater agreement between auditors ranged from fair to substantial for all categories (κ = 0.24–0.80). Criterion validity was found to be moderate to almost perfect (κ = 0.56–0.82) for most categories, except aesthetics and grocery stores (κ = 0.26–0.35).ConclusionThe adapted version of the S-VAT can be used to provide reliable and valid data on built environment characteristics deemed relevant for physical activity and dietary behavior among adolescents.
Highlights
The global burden of obesity amongst adolescents has increased more than eightfold from 0.7 to 5.6% in girls and 0.9% to 7.8% in boys, in the past 40 years [1]
The adapted version of the SPOTLIGHT Virtual Audit Tool (S-VAT) can be used to provide reliable and valid data on built environment characteristics deemed relevant for physical activity and dietary behavior among adolescents
As Cohen’s kappa is a relative measure and a low kappa can be observed despite high agreement, we reported percent agreement [46, 47]
Summary
The global burden of obesity amongst adolescents has increased more than eightfold from 0.7 to 5.6% in girls and 0.9% to 7.8% in boys, in the past 40 years [1]. The built environment can be defined as man-made structures such as neighborhoods, roads, buildings, food sources and recreational facilities in which people live, work, are educated, eat and play [5]. These characteristics are thought to facilitate or impede physical activity (PA) and healthy eating behavior [6,7,8]. Very few aspects of the built environment have been consistently associated with these health behaviors among adolescents [9, 10]. Physical inactivity and unhealthy diet are key behavioral determinants underlying obesity. There is a need for a tool that combines the assessment of food and activity environments, and which focuses on aspects of the environment relevant for youth
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