Assessment of neighbourhood park characteristics for physical activity among youth

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1 Assessment of neighbourhood park characteristics for physical activity among youth Madeleine Bird 1,2, Geetanjali Datta 3,1, Andraea van Hulst 1,2, Yan Kestens 1,3, Marie Lambert 4,2! & Tracie Barnett 1,2 ICDAM8 14 May Department of Social and Preventive Medicine, University of Montreal 2. CHU Sainte-Justine Research Center 3. Centre de Recherche du Centre Hospitalier de l Université de Montréal (CRCHUM) 4. Paediatric Department, University of Montreal! Dr. Marie Lambert passed away on She will be remembered for her leadership and devotion to the QUALITY Cohort. 1

2 Background Prevalence of obesity among youth in Canada: 3% in % in fitness levels have decreased 2 Physical activity (PA) a modifiable behaviour Youth with more access to parks more active than those with less 3 Parks: Present opportunity for PA Popular setting for PA among youth 4 Accessible in Montreal 5 Still little known about objectively measured parks characteristics and PA among youth specifically 1. Shields, Tremblay et all., Sallis et al., McCormak, Rock, Toohey, & Hignell, Apparicio, Cloutier, Séguin & Ades, 2010

3 Today s Goals Presentation of: 1. Youth-oriented direct-observation park evaluation tool 2. Reliability estimates 3. Operationalization of conceptual model 4. Results from exploratory principal component analysis 3

4 QUALITY Cohort QUebec Adipose and Lifestyle InvesTigation in Youth (QUALITY) Cohort, an ongoing longitudinal investigation of the natural history of obesity and cardiovascular risk among youth with parents with a history of obesity Lambert M, van Hulst A, O Loughlin J, et al Cohort Profile: The Quebec Adipose and Lifestyle Investigation in Youth Cohort, International Journal of Epidemiology. 4

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6 PARK Tool Development Public Open Space Tool (POST) Bedimo-Rung Assessment Tool Direct Observation (BRAT-DO) New items (n=16) Final result: 90-item Physical Activity and Recreation among Kids (PARK) tool 6

7 PARK Tool Domains 1. Activities (17-items and 39 sub-items) 2. Environmental Quality (9-items and 3 sub-items) 3. Services (10 items and 2 sub-items) 4. Perceived Safety (6 items) 5. General Impression (6 items) 7

8 Data Collection Methods Parks pre-identified using DMTI Up to the 3 closest to home of family within 500m or 1000m (n=512) 5 independent observer pairs (10 observers) 584 unique parks evaluated 231 identified on-site 96% between June Oct. (none Jan. April) 76% in 2008; 21% in 2009; 3%

9 Strategies to Promote High Reliability 1. Photographs used to illustrate items during training 2. Iterative 9-day training with oral feedback given to observers and discordance discussed with trainer (gold standard) 3. Reliability assessment following observer training (83% agreement) 4. Reduction in number of response options 5. Personal Digital Agendas used to collect and impute data 9

10 Reliability of PARK Tool Estimates Calculated: Inter-Observer Reliability: % Agreement Cohen s Kappa Intra-Observer Reliability (Test-retest): % Agreement Correlation r Cohen s Kappa 10

<0 = Poor 0-.2 = Slight.21-.4 = Fair.41-.6 = Moderate.61-.

11 Statistical Analyses Percent Agreement categorization 1 :!75% Good to excellent 60-74% Moderate <60% Poor Cohen s Kappa 2 : <0 = Poor 0-.2 = Slight = Fair = Moderate = Substantial.81-1 = Almost perfect 1. Saelens et al., Landis & Koch, 1977

12 Results: Inter-Observer Reliability % Agreement: 85.5% of items! 75% agreement Kappa: 82.5% of items between.41 1 or moderate to almost perfect agreement 28% = % = % =

13 Inter-Observer Reliability: Top and Bottom Five Item 95% CI Hockey Rink Accessible Multi-use Space Accessible Pool Present Soccer/Football Field Present ; 1.00 Top 5 Items Hockey Rink Present ; 1.00 Item 95% CI Skate Park Restriction ;.460 Vandalism Present ;.309 School Yard Condition ;.472 Multi-use Space Condition ;.401 Path Condition ;.494 Bottom 5 Items 13

14 Test-Retest Results: Intra- Observer Reliability Items r (95% CI) Pond/Fountain (1.00) Benches 1.00 n/a Soccer field (.836; 1.00) School yard (.830; 1.00) Tennis court (.821; 1.00) Item r (95% CI) 1 House visible (-.035;.673 ) Parking (.382;.904) Bike path.466 n/a Pedestrian facilitators (.231;.691) Shade (.110;.702 Top Items 51% of all testretest items had r! 0.70 Bottom Items 19% of all testretest items had r "

15 PARK Tool vs. POST Item PARK (n=584) 6+ Play Area Present.936 Large Body of Water Present.918 Drinking Fountain Present.912 Public Toilets Present.904 Picnic Tables Present.845 Trail/ Walking Path Present.604 Sufficient Lighting for Park.594 At Least 1 House Visible from Center.551 Graffiti Present.521 Litter Present

16 PARK Tool vs. POST Item PARK (n=584) POST (n=47) PARK % Agree POST % Agree 6+ Play Area Present Large Body of Water Present Drinking Fountain Present Public Toilets Present Picnic Tables Present Trail/ Walking Path Present Sufficient Lighting for Park At Least 1 House Visible from Center Graffiti Present Litter Present

17 Operationalization of Bedimo- Rung (2005) Model Features Physical Activity Installations Activity Areas Condition Maintenance Incivilities Access Physical Activity Installation and Activity Area Aesthetics Design Attractiveness Park Characteristics Safety Perceived Amenities Supporting Areas Amenities for Vehicle Access Area Park area Context Surrounding Neighbourhood 17

18 Principal Component Analysis What variables correlate with each other? What does this tell us? PCA is calculated using all of the variance Often used as data reduction technique No a priori hypothesis about underlying structure (by design) Ultimate goal of finding out if our variables hung together in the Bedimo-Rung Conceputal Model 18

19 PCA Methods Categorical variables dichotomized Variables with <5% frequency removed Variables that did not apply to all parks removed Rotation method: Orthogonal rotation (components are not correlated) Maximization of variation (varimax) Factors retained at a minimum eigenvalue of.95 Items retained if loaded onto factor at.3 or higher N appropriate for PCA 19

20 PCA Results 10 principal components retained, explaining almost 60% of the variance in the data (minimum eigenvalue 0.992) Some principal components can be explained by some domains from conceptual model 20

21 Team Sports Oriented Features (8 items) Large Park Features (3 items) Walking Oriented Features (3 items) Pool Features (3 items) Activity Features School Yard Features (4 items) Play Area Features (4 items) Cycling Oriented Features (3 items) Aesthetically Pleasing (3 items) Condition Incivilities (3 items) Safety Perceived Safety (3 items) Aesthetics 21

22 Limitations Reliability Results Study not designed to assess test-retest reliability PCA Many variables crossloaded Some safety items may be capturing park size rather than safety 22

23 Conclusions PARK tool generally reliable Objective items performed better than subjective Some items can be used reliably across different geographical contexts, observers, training methods, etc. Amenities may not be a unique park concept but supports different activity features Next Steps: assess relationships between principal components and PA among youth 23

Marie-Claude Gendron Ste-Justine UHC Foundation and

24 Many Thanks! Tracie A. Barnett Geetanjali D. Datta Andraea van Hulst Yan Kestens Marie Lambert Marie-Claude Gendron Ste-Justine UHC Foundation and Foundation of Stars for financial contribution ICDAM8 Conference Organizers 24

Additional Acknowledgments This research was conducted by members of

de Montréal, Concordia University, Université Laval, McGill

The QUALITY Cohort is funded by the Canadian Institutes of Health

25 Additional Acknowledgments This research was conducted by members of TEAM PRODIGY, an inter-university research team including Université de Montréal, Concordia University, Université Laval, McGill University and INRS-Institut Armand Frappier. The QUALITY Cohort is funded by the Canadian Institutes of Health Research, the Heart and Stroke Foundation of Canada and Fonds de la recherche en santé du Québec. 25

26 ACTIVITIES ITEM Kappa 95% CI % Agreement Park Type ; Tennis Courts Present ; Tennis Accessible ; Tennis Condition ; Tennis Restriction ; Basketball Courts Present ; Basketball Accessible Basketball Condition ; Basketball Restriction ; Badminton/Volleyball Courts Present ; Badminton/Volleyball Accessible Badminton/Volleyball Condition ; Badminton/Volleyball Restriction Soccer/Football/Rugby Field Present ; Soccer/Football/Rugby Accessible ; Soccer/Football/Rugby Condition ; Soccer/Football/Rugby Restriction ; Baseball/Softball Field Present ; Baseball/Softball Accessible ; Baseball/Softball Condition ; Baseball/Softball Restriction ; Hockey/Ringette Rink Present ; Hockey/Ringette Accessible Hockey/Ringette Condition ; Hockey/Ringette Restriction ;

27 ACTIVITIES ITEM Kappa 95% CI % Agreement Track (Track & Field) Present ; Track Accessible Track Condition ; Trail Present ; Trail Accessible Trail Condition ; Bike Path Present ; Bike Path Accessible 100 Bike Path Condition Skate Park Present ; Skate Park Accessible 100 Skate Park Condition ; Skate Park Restriction ; Play Area Present ; Play Area Accessible Play Area Condition ; Multi-Use Area Present ; Multi-Use Area Accessible Multi-Use Area Condition ; School Yard Present ; School Yard Accessible ; School Yard Condition ; Equipment Rental Available ; Pool Present Length of Pool Pool Condition ; Pool Cleanliness ; Water Sprinklers Present ; Water Sprinklers Condition ; Water Sprinklers Cleanliness ;

28 ENVIRONMENTAL QUALITY ITEM Kappa 95% CI % Agreement Large Body of Water Present ; Sportive Aquatic Activities Present ; Pond or Fountain Present ; Aquatic Activities Present 100 Decorative or Cultural Features ; Garden Present ; Shady Areas Present ; No Dogs Allowed Sign Present ; Graffiti Present ; Vandalism Present ; Litter Present ; SERVICES ITEM Kappa 95% CI % Agreement Garbage Bins Present ; Drinking Fountain Present ; Picnic Tables Present ; Sitting Benches Present ; Bleachers Present ; Public Toilets ; Condition of Toilets ; Chalet/ Change Room Present ; Condition of Chalet/ Change Room Parking Present ; Bike Locks Present ; Public Transportation Present ;

29 SAFETY ITEM Kappa 95% CI % Agreement Sufficient Lighting for Park ; At Least 1 Street Visible from Center ; At Least 1 House Visible from Center ; Adjacent Streets Local ; Traffic Calming Measures Present ; Pedestrian Safety Present ; GENERAL IMPRESSION ITEM Kappa 95% CI % Agreement Overall Appealing for Youth ; Overall Safe ; Overall Attractive/Pretty ; Attractive for Walking ; Attractive for Bicycling ; Attractive for Active Play ; kappa is weighted kappa could not be calculated due to a lack of response variation between observers 29

30 Item r p-value r 2 kappa 95% CI Tennis Courts Present.941 < ; 1.00 Basketball Courts Present.839 < ; 1.00 Badminton/Volleyball Courts Present.854 < ; 1.00 Soccer/Football/Rugby Field Present.946 < ; 1.00 Baseball/Softball Field Present.898 < ; 1.00 Hockey/Ringette Rink Present ;.010 Trail Present.733 < ;.979 Bike Path Present ;.896 Skate Park Present.854 < ; Play Area Present.804 < ; 1.00 Multi-Use Area Present.605 < ;.861 School Yard Present.943 < ; 1.00 Pool Present.806 < ; 1.00 Water Sprinklers Present.629 < Large Body of Water Present.854 < ; 1.00 Decorative or Cultural Features.577 < ;.875 Garden Present ;.767 No Dogs Allowed Sign Present.711 < ;.916 Bleachers Present.784 < Chalet/ Change Room Present.741 < ;.948 Bike Locks Present.632 < ;.878 Public Transportation Present.692 < ;.917 Sufficient Lighting for Park ;.861 At Least 1 Street Visible from Center ;.826 At Least 1 House Visible from Center ;

31 Item r p-value r 2 kappa 95% CI Park Type.709 < ; 1.00 Shady Areas Present ;.702 Pond or Fountain Present 1.00 < Public Toilets.718 < ;.934 Parking Present ;.904 Graffiti Present ;.716 Vandalism Present ;.839 Litter Present ;.604 Drinking Fountain Present.709 < ;.835 Picnic Tables Present ;.821 Adjacent Streets Local.801 < ;.920 Traffic Calming Measures Present ;.626 Pedestrian Safety Present ;.691 Overall Appealing for Youth.651 < ;.705 Overall Safe ;.693 Overall Attractive/Pretty.754 < ;.861 Attractive for Walking.736 < ;.787 Attractive for Bicycling.905 < ; 1.00 Attractive for Active Play.696 < ;.846 indicates kappa is weighted r = The Pearson Product Moment correlation between park evaluation time 1 and time 2 by the same observer p-value = 95% r 2 = the coefficient of determination or the proportion of common variation between park evaluation time 1 and time 2 CI = confidence interval 31

32 PARK Tool vs POST: All Items PARK** (n=584) POST * (n=47) % % Item Kappa Agreement Kappa Agreement 6+ Play Area Present Large Body of Water Present Drinking Fountain Present Public Toilets Present Picnic Tables Present Parking Present Garbage Bins Present No Dogs Allowed Sign Present Public Transportation Present Sitting Benches Present Chalet/ Change Room Present At Least 1 Street Visible from Center Trail/ Walking Path Present Sufficient Lighting for Park At Least 1 House Visible from Center Graffiti Present Litter Present *Data printed with permission from the author, B. Giles-Corti. **All categorical items have been dichotomized 32

33 Reliability estimates of new items New Item Kappa 95% CI % Agreement Badminton/Volley ; Badminton/Volley Accessible!! Badminton/Volley Condition ; Badminton/Volley Restriction!! Hockey Accessible Hockey Condition ; Hockey Restriction ; Track & Field Accessible!! Track & Field Condition ; Skate park ; Skate Park Accessible!! Skate Park Condition ; Skate Park Restriction ; School Yard ; School Yard Accessible ; School Yard Condition ; Equipment rental ; Appealing for youth ; Overall safety ; Attractive for active play ;

34 Bedimo-Rung Conceptual Model (2005) Park characteristics Geographic Areas Activity areas Supporting areas Overall park Surrounding neighbourhood Features Facilities Programs Diversity Condition Maintenance Incivilities Access Availability Equitable Individual Within park Aesthetics Design Attractiveness Safety Perceived Objective Policies Management Budget 34

35 Principal Components 35

36 PCA: Items That Crossloaded Item Component Loading Toilets Pool Oriented 0.46 Parking Cycling Oriented 0.30 Larger Park 0.36 Appealing for Youth Play Area 0.40 School Yard Team Sports Oriented 0.34 Bike Locks Walking Oriented 0.34 Overall Pretty Cycling Oriented 0.31 Tennis Team Sports Oriented 0.39 Sprinklers Pool Oriented 0.39 Safety Attractive for Walking Cycling Oriented 0.33 Aesthetically Pleasing 0.31 Decorative Elements Aesthetically Pleasing

General Impression Items: Intra and Inter-Observer comparison Item Appealing for youth Overall safe Overall aesthetically pleasing Appealing for

37 General Impression Items: Intra and Inter-Observer comparison Item Appealing for youth Overall safe Overall aesthetically pleasing Appealing for walking Appealing for cycling Appealing for active play Intra-Observer (n=40) Inter-Observer (n=584)

38 38

Summary Report: Built Environment, Health and Obesity

Research and education Built Environment Edmonton Project Summary Report: Built Environment, Health and Obesity Introduction In 2007 the Canadian Institutes of Health Research and the Heart and Stroke