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 2012 1. 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 20-02-2012. She will be remembered for her leadership and devotion to the QUALITY Cohort. 1
Background Prevalence of obesity among youth in Canada: 3% in 1979 9% in 2004 1 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, 2006 2. Tremblay et all., 2010 3. Sallis et al., 1992 4. McCormak, Rock, Toohey, & Hignell, 2010 5. Apparicio, Cloutier, Séguin & Ades, 2010
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
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. 1 1. Lambert M, van Hulst A, O Loughlin J, et al. 2011. Cohort Profile: The Quebec Adipose and Lifestyle Investigation in Youth Cohort, International Journal of Epidemiology. 4
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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
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
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% 2010 8
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
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
Statistical Analyses Percent Agreement categorization 1 :!75% Good to excellent 60-74% Moderate <60% Poor Cohen s Kappa 2 : <0 = Poor 0-.2 = Slight.21-.4 = Fair.41-.6 = Moderate.61-.8 = Substantial.81-1 = Almost perfect 1. Saelens et al., 2006 2. Landis & Koch, 1977
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% =.41-.60 27% =.61-.80 28.5% =.81-1 12
Inter-Observer Reliability: Top and Bottom Five Item 95% CI Hockey Rink Accessible 1.00 1.00 Multi-use Space Accessible 1.00 1.00 Pool Present 1.00 1.00 Soccer/Football Field Present.984.968; 1.00 Top 5 Items Hockey Rink Present.982.947; 1.00 Item 95% CI Skate Park Restriction.100 -.260;.460 Vandalism Present.226.143;.309 School Yard Condition.228 -.017;.472 Multi-use Space Condition.229.057;.401 Path Condition.264.035;.494 Bottom 5 Items 13
Test-Retest Results: Intra- Observer Reliability Items r (95% CI) Pond/Fountain 1.00 1.00 (1.00) Benches 1.00 n/a Soccer field.946.944 (.836; 1.00) School yard.943.942 (.830; 1.00) Tennis court.941.939 (.821; 1.00) Item r (95% CI) 1 House visible.339.319 (-.035;.673 ) Parking.446.643 (.382;.904) Bike path.466 n/a Pedestrian facilitators.475.461 (.231;.691) Shade.477.406 (.110;.702 Top Items 51% of all testretest items had r! 0.70 Bottom Items 19% of all testretest items had r " 0.50 14
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.371 15
PARK Tool vs. POST Item PARK (n=584) POST (n=47) PARK % Agree POST % Agree 6+ Play Area Present.936 1.00 97.77 100.0 Large Body of Water Present.918.876 98.97 97.70 Drinking Fountain Present.912.746 95.71 87.20 Public Toilets Present.904.849 95.70 95.60 Picnic Tables Present.845.956 92.44 -- Trail/ Walking Path Present.604.707 80.89 85.10 Sufficient Lighting for Park.594.675 83.50 85.10 At Least 1 House Visible from Center.551.486 86.75 89.30 Graffiti Present.521.565 76.46 78.26 Litter Present.371.495 71.38 76.00 16
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
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
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
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
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
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
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
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 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
ACTIVITIES ITEM Kappa 95% CI % Agreement Park Type.720.657;.784 88.25 Tennis Courts Present.980.958; 1.00 99.48 Tennis Accessible.690.459;.920 84.09 Tennis Condition.325 -.049;.699 92.04 Tennis Restriction.500.319;.681 75.00 Basketball Courts Present.904.860;.949 97.08 Basketball Accessible 98.00 Basketball Condition.292.084;.499 73.00 Basketball Restriction.490 -.119; 1.00 98.00 Badminton/Volleyball Courts Present.892.813;.971 98.80 Badminton/Volleyball Accessible 96.77 Badminton/Volleyball Condition.520.163;.877 83.87 Badminton/Volleyball Restriction 89.66 Soccer/Football/Rugby Field Present.984.968; 1.00 99.31 Soccer/Football/Rugby Accessible.886.669; 1.00 99.44 Soccer/Football/Rugby Condition.380.181;.578 86.6 Soccer/Football/Rugby Restriction.477.168; 0.786 95.48 Baseball/Softball Field Present.956.928; 0.983 98.28 Baseball/Softball Accessible.759.495; 1.00 97.96 Baseball/Softball Condition.559.354;.763 90.47 Baseball/Softball Restriction.437.091;.783 95.20 Hockey/Ringette Rink Present.982.947; 1.00 99.83 Hockey/Ringette Accessible 1.00 1.00 100 Hockey/Ringette Condition.661.309; 1.00 89.29 Hockey/Ringette Restriction.651.020; 1.00 96.55 26
ACTIVITIES ITEM Kappa 95% CI % Agreement Track (Track & Field) Present.638.473;.803 97.25 Track Accessible 93.33 Track Condition.400 -.090;.890 73.33 Trail Present.604.538;.670 80.89 Trail Accessible 99.65 Trail Condition.264.035;.494 93.40 Bike Path Present.747.652;.842 95.71 Bike Path Accessible 100 Bike Path Condition 95.24 Skate Park Present.977.944; 1.00 99.65 Skate Park Accessible 100 Skate Park Condition.657.0313; 1.00 97.78 Skate Park Restriction.100 -.260;.460 82.22 6+ Play Area Present.936.901;.970 97.77 6+ Play Area Accessible 99.32 6+ Play Area Condition.280.106;.453 92.34 Multi-Use Area Present.594.527;.661 80.93 Multi-Use Area Accessible 1.00 1.00 100 Multi-Use Area Condition.229.057;.401 88.68 School Yard Present.959.931;.987 98.63 School Yard Accessible.654.2883; 1.00 97.50 School Yard Condition.228 -.017;.472 84.87 Equipment Rental Available.664.307; 1.00 99.49 Pool Present 1.00 1.00 100 Length of Pool 72.00 Pool Condition.464.119;.809 77.55 Pool Cleanliness.627.379;.876 75.50 Water Sprinklers Present.88.817;.948 97.94 Water Sprinklers Condition.893.723; 1.00 96.00 Water Sprinklers Cleanliness.557.291;.823 76.00 27
ENVIRONMENTAL QUALITY ITEM Kappa 95% CI % Agreement Large Body of Water Present.918.852;.983 98.97 Sportive Aquatic Activities Present.683.431;.935 86.11 Pond or Fountain Present.704.544;.863 97.93 Aquatic Activities Present 100 Decorative or Cultural Features.556.474;.637 84.70 Garden Present.607.541;.672 80.93 Shady Areas Present.523.464;.582 67.42 No Dogs Allowed Sign Present.766.714;.819 88.31 Graffiti Present.523.462;.585 69.58 Vandalism Present.226.143;.309 76.21 Litter Present.418.344;.491 67.24 SERVICES ITEM Kappa 95% CI % Agreement Garbage Bins Present.811.702;.920 97.93 Drinking Fountain Present.920.890;.949 94.84 Picnic Tables Present.850.807;.893 92.44 Sitting Benches Present.680.570;.789 95.00 Bleachers Present.914.881;.947 95.54 Public Toilets.822.772;.871 92.09 Condition of Toilets.834.758;.909 90.29 Chalet/ Change Room Present.669.585;.754 91.24 Condition of Chalet/ Change Room 81.54 Parking Present.728.675;.781 86.21 Bike Locks Present.842.798;.886 92.08 Public Transportation Present.755.700;.809 88.30 28
SAFETY ITEM Kappa 95% CI % Agreement Sufficient Lighting for Park.594.522;.667 83.50 At Least 1 Street Visible from Center.649.572;.727 88.64 At Least 1 House Visible from Center.551.463;.640 86.75 Adjacent Streets Local.612.546;.679 82.30 Traffic Calming Measures Present.446.381;.511 63.24 Pedestrian Safety Present.646.594;.698 73.88 GENERAL IMPRESSION ITEM Kappa 95% CI % Agreement Overall Appealing for Youth.481.426;.537 60.13 Overall Safe.346.279;.413 56.70 Overall Attractive/Pretty.357.292;.422 58.07 Attractive for Walking.532.474;.589 66.67 Attractive for Bicycling.597.525;.670 81.78 Attractive for Active Play.540.489;.591 62.20 kappa is weighted kappa could not be calculated due to a lack of response variation between observers 29
Item r p-value r 2 kappa 95% CI Tennis Courts Present.941 <.0001.885.939.821; 1.00 Basketball Courts Present.839 <.0001.704.827.641; 1.00 Badminton/Volleyball Courts Present.854 <.0001.730.844.545; 1.00 Soccer/Football/Rugby Field Present.946 <.0001.894.944.836; 1.00 Baseball/Softball Field Present.898 <.0001.806.898.760; 1.00 Hockey/Ringette Rink Present -.026 0.8752.001 -.026 -.0612;.010 Trail Present.733 <.0001.538.733.488;.979 Bike Path Present.466 0.0024.218.448.001;.896 Skate Park Present.854 <.0001.730.844.545;1.00 6+ Play Area Present.804 <.0001.646.804.541; 1.00 Multi-Use Area Present.605 <.0001.365.595.330;.861 School Yard Present.943 <.0001.890.942.830; 1.00 Pool Present.806 <.0001.649.787.385; 1.00 Water Sprinklers Present.629 <.0001.395 Large Body of Water Present.854 <.0001.730.844.5451; 1.00 Decorative or Cultural Features.577 <.0001.333.571.268;.875 Garden Present.495 0.0012.245.495.224;.767 No Dogs Allowed Sign Present.711 <.0001.505.696.477;.916 Bleachers Present.784 <.0001.615 Chalet/ Change Room Present.741 <.0001.549.731.514;.948 Bike Locks Present.632 <.0001.400.632.385;.878 Public Transportation Present.692 <.0001.479.688.460;.917 Sufficient Lighting for Park.504 0.0009.254.479.097;.861 At Least 1 Street Visible from Center.532 0.0004.283.521.215;.826 At Least 1 House Visible from Center.339 0.0321.115.319 -.035;.673 30
Item r p-value r 2 kappa 95% CI Park Type.709 <.0001.503.793.548; 1.00 Shady Areas Present.477 0.0018.228.406.110;.702 Pond or Fountain Present 1.00 <.0001 1.00 1.00 1.00 Public Toilets.718 <.0001.516.725.516;.934 Parking Present.446 0.0039.199.643.382;.904 Graffiti Present.556 0.0002.309.470.224;.716 Vandalism Present.499 0.001.249.503.167;.839 Litter Present.508 0.0008.258.377.150;.604 Drinking Fountain Present.709 <.0001.502.629.422;.835 Picnic Tables Present.549 0.0002.301.546.270;.821 Adjacent Streets Local.801 <.0001.641.743.566;.920 Traffic Calming Measures Present.559 0.0002.313.379.132;.626 Pedestrian Safety Present.475 0.002.226.461.231;.691 Overall Appealing for Youth.651 <.0001.424.492.279;.705 Overall Safe.555 0.0002.308.479.266;.693 Overall Attractive/Pretty.754 <.0001.568.658.455;.861 Attractive for Walking.736 <.0001.542.593.398;.787 Attractive for Bicycling.905 <.0001.819.844.673; 1.00 Attractive for Active Play.696 <.0001.485.646.446;.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
PARK Tool vs POST: All Items PARK** (n=584) POST * (n=47) % % Item Kappa Agreement Kappa Agreement 6+ Play Area Present.936 97.77 1.00 100.00 Large Body of Water Present.918 98.97.876 97.70 Drinking Fountain Present.912 95.71.746 87.20 Public Toilets Present.904 95.70.849 95.60 Picnic Tables Present.845 92.44.956 -- Parking Present.829 92.41.744 87.20 Garbage Bins Present.789 97.93.691 93.60 No Dogs Allowed Sign Present.766 88.31.849 95.70 Public Transportation Present.755 88.30.539 76.00 Sitting Benches Present.680 95.00.877 97.70 Chalet/ Change Room Present.669 91.24 1.00 100.00 At Least 1 Street Visible from Center.649 88.64.789 97.90 Trail/ Walking Path Present.604 80.89.707 85.10 Sufficient Lighting for Park.594 83.50.675 85.10 At Least 1 House Visible from Center.551 86.75.486 89.30 Graffiti Present.521 76.46.565 78.26 Litter Present.371 71.38.495 76.00 *Data printed with permission from the author, B. Giles-Corti. **All categorical items have been dichotomized 32
Reliability estimates of new items New Item Kappa 95% CI % Agreement Badminton/Volley 0.892 0.813; 0.971 98.80 Badminton/Volley Accessible!! 96.77 Badminton/Volley Condition 0.520 0.163; 0.877 83.87 Badminton/Volley Restriction!! 89.66 Hockey Accessible 1.00 1 100.00 Hockey Condition 0.661 0.309; 1.00 89.29 Hockey Restriction 0.651 0.020; 1.00 96.55 Track & Field Accessible!! 93.33 Track & Field Condition 0.400-0.090; 0.900 73.33 Skate park 0.976 0.944;1.00 99.65 Skate Park Accessible!! 100.00 Skate Park Condition 0.657 0.031; 1.00 97.78 Skate Park Restriction 0.100-0.260; 0.460 82.22 School Yard 0.959 0.931; 0.987 98.63 School Yard Accessible 0.654 0.288; 1.00 97.50 School Yard Condition 0.228-0.017; 0.472 84.87 Equipment rental 0.664 0.307; 1.00 99.49 Appealing for youth 0.481 0.426; 0.537 60.13 Overall safety 0.346 0.279; 413 56.70 Attractive for active play 0.540 0.489; 0.591 62.20 33
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
Principal Components 35
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 -0.34 Attractive for Walking Cycling Oriented 0.33 Aesthetically Pleasing 0.31 Decorative Elements Aesthetically Pleasing 0.31 36
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).492.481.479.346.658.357.593.532.844.597.646.540 37
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