- Email: [email protected]
Test–retest reliability of the Physical Activity Neighborhood Environment Scale among school students in China
p u b l i c h e a l t h 1 3 0 ( 2 0 1 6 ) 9 1 e9 4
Available online at www.sciencedirect.com
Public Health journal homepage: www.elsevier.com/puhe
Short Communication
Testeretest reliability of the Physical Activity Neighborhood Environment Scale among school students in China F. Xu a,b,*, E. Leslie c, Z. Wang a, H. Zhou a, N. Owen d,e a
Nanjing Municipal Centre for Disease Control and Prevention, Nanjing, China School of Public Health, Nanjing Medical University, Nanjing, China c School of Medicine, Flinders University, Adelaide, Australia d Behavioural Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia e School of Population Health, The University of Queensland, Brisbane, Australia b
article info Article history: Received 27 October 2014 Received in revised form 26 June 2015 Accepted 1 October 2015 Available online 1 November 2015
Introduction It has been well documented that regular physical activity (PA) has important benefits for health.1,2 A PA-friendly built environment has emerged as a promising approach for PA promotion at population level.2e6 It is of great importance to use reliable instruments to assess the attributes of the built environment in order to investigate its impact on PA among people. Geographic Information Systems (GIS) have been used to measure built environment correlates objectively for public health purposes. However, the high cost and complicated technical support of GIS limit wide use. Therefore, a reliable and easily applicable instrument is needed to assess the attributes of the built environment at population level. The
environmental module developed for the International Physical Activity Prevalence Study provides a short-form environmental measure, the Physical Activity Neighborhood Environment Scale (PANES) (formerly named the International Physical Activity Questionnaire Environmental Module), that can meet this need.7 PANES has been shown to have good testeretest reliability in Swedish, Nigerian and USA adult samples, and is usually adaptable for use in international studies with single items.8e10 Considering the rapid urbanization and the increasing prevalence of physical inactivity among adolescents in Mainland China (i.e. average sedentary behaviour time is approximately 70 h/week among Chinese school students),5 it is of importance to identify factors of the built environment that may influence PA in Chinese adolescents. To examine the reliability of a Chinese version of PANES (PANES-CHN) among urban Chinese school students, this testeretest study was conducted in urban areas of Nanjing, one of the largest cities in eastern China. The first survey was conducted in early May 2013, and the retest survey was conducted 7 days later. Written informed consent forms were obtained from participating schools, students and parents/ guardians. The Academic and Ethical Committee of Nanjing Municipal Centre for Disease Control and Prevention reviewed and approved this study. The participants were selected from Grades 4 to 12 (approximately 10e18 years old) from primary and high schools using a multistage sampling method. First, two urban
* Corresponding author. Nanjing Municipal Centre for Disease Control and Prevention, 2, Zizhulin, Nanjing 210003, PR China. Tel.: þ86 25 8353 8305. E-mail address: [email protected] (F. Xu). http://dx.doi.org/10.1016/j.puhe.2015.10.001 0033-3506/© 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
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districts were selected at random. Next, one school was chosen at random from all primary, junior and senior high schools, respectively, within each selected district. Next, one class was chosen at random from each grade within each selected school. All students within the selected classes were eligible participants. Based on the overall sample size in previous studies (ranging from 98 to 298),7e9 the sample size in this study was estimated to be approximately 270 for each type of school (90 for each grade), and 810 in total, to guarantee sufficient statistical power in each type of school (primary, junior and senior high school). The final number of eligible participants was 884 based on this sampling approach. PANES-CHN was translated from the original English PANES through a strict and standardized procedure, including translation and back-translation, pilot study using initial PANES-CHN, and panel review and assessment. In China, apartments have been built according to regulations as: (1) seven or fewer storeys, usually without elevators; or (2) eight or more storeys, compulsorily with elevators. Thus, the specific response options for Item 1 (main type of housing) were modified to include these options. The full PANES-CHN is available on request from the corresponding author. PANES consisted of 17 items regarding attributes of the local built environment, with the ‘neighbourhood’ specifically defined as a 10e15-min walk from home. These 17 questions were categorized into three subgroups: seven core items (consisting of residential density, access to destinations, neighbourhood infrastructure and neighbourhood safety), four recommended items (comprising neighbourhood safety, social environment, aesthetic qualities and household motor vehicle) and six optional items (including access to destinations, neighbourhood infrastructure, street connectivity and neighbourhood safety). Four-point Likert response scales ranging from ‘strongly disagree’ to ‘strongly agree’, as well as ‘don't know’ or ‘doesn't apply’ options, were used for 15 questions, with two exceptions: Item 1, which asks about the main type of housing in the neighbourhood (to assess residential density); and Item 11, which asks for the number of household motor vehicles (numerical value; ‘don't know/not sure’). The testeretest reliability for each environmental attribute was estimated using intraclass correlation coefficient (ICC) and percentage agreement. Differences in percentage agreement between the sexes and school types were examined using Chi-squared analysis.
Reliability of PANES-CHN Of the 884 eligible participants, 847 were recruited for the firstround survey (participation rate 95.8%). One week later, all 847 students completed the retest survey (follow-up rate 100%). The mean age of participants was 14.2 [standard deviation (SD) 2.6] years [boys vs girls: 14.0 (SD 2.5) years vs 14.4 (2.7) years]. There were 427 (50.4%) boys, 269 (31.8%) primary school students, 298 (35.2%) junior high school students and 280 (33.1%) senior high school students. Table 1 shows the ICC values and percentage agreement for each built environment item by sex and school type. Overall, the ICC ranged from 0.49 (Item 6, access to
destinations) to 0.84 (Item 1, residential density) for the core items, from 0.48 (Item 10, aesthetic qualities) to 0.62 (Item 8, neighbourhood safety) for the recommended items, and from 0.42 (Items 12 and 17, street connectivity and access to destinations, respectively; the lowest ICC value among all 17 items) to 0.68 (Item 16, neighbourhood safety) for optional items, while the item regarding the number of household motor vehicles had the highest ICC value of 0.96. Among the 17 items, only Item 1 was found to be significantly different in terms of percentage agreement between boys and girls (c2 ¼ 7.51, P < 0.05), and Item 12 differed significantly between primary schools and senior high schools (c2 ¼ 7.03, P < 0.05). Generally, no differences in PANES-CHN were found between the sexes and school types. To the authors' knowledge, this is the first study to assess the testeretest reliability of PANES in primary and high school students. Moderate reliability was found for the majority of PANES-CHN items, and substantial reliability was found for a few PANES-CHN among the students, regardless of sex and school type, suggesting that PANES-CHN items may be acceptable for use in Chinese school students. Although the participants were younger than their counterparts in previous studies, the finding of moderate reliability for PANES-CHN items was generally similar to adult studies.8e10 Compared with findings among adults, five of the seven core items had lower ICC values and two had higher ICC values. For the recommended items, two of the four items had lower ICC values and two had higher ICC values in the study population.8e10 The highest ICC and percentage agreement values were found for Items 1 (main type of neighbourhood housing) and 11 (number of household motor vehicles), which was similar to the results found among adults.8e10 However, the lowest ICC values (0.42) were seen for Items 12 (street connectivity) and 17 (access to destinations) (both optional items), which was in contrast to the findings from adult studies.8e10 Adolescents experience body growth, including physical and intellectual development; and gradual adaptation to social, cultural and environmental contexts. They may have different sensitivity and judgement ability in relation to their neighbourhood environment compared with adults. For example, it is easier for adolescents to report objective counts or descriptions (i.e. number of household motor vehicles) than subjective ratings (i.e. easy walking distance of home). China, the most populous society in the world, may have different social and cultural contexts of the neighbourhood environment compared with other societies. These issues may, at least in part, explain the differences in ICC for several PANES items between Chinese adolescents and adults in other countries. Several factors influence testeretest reliability of an instrument. Time between survey administrations may affect the reliability of an instrument's testeretest. In this study, the interval between the two surveys was exactly 7 days, which would warrant minimal change in neighbourhood built environment attributes. Additionally, some subjectively perceived items, such as safety, may be influenced by occasional events; however, during the survey period, no notable safety events were reported by any local media coverage.
Table 1 e Intraclass correlation coefficients (ICC) and percentage agreement between two tests among students by sex and school type. Environmental variablesa
ICC (percentage agreement between two tests)b Overall (n ¼ 847)
a
b
School Girls (n ¼ 420)
Primary (n ¼ 269)
Junior high (n ¼ 298)
Senior high (n ¼ 280)
0.84 (85.7) 0.53 (65.3)
0.82 (82.4) 0.51 (63.7)
0.86 (89.0b) 0.56 (66.9)
0.80 (82.9) 0.46 (64.7)
0.85 (85.2) 0.53 (65.8)
0.87 (88.9) 0.62 (65.4)
0.52 (65.2) 0.58 (50.4) 0.55 (48.1)
0.53 (63.9) 0.58 (49.9) 0.58 (48.2)
0.49 (66.4) 0.58 (51.0) 0.51 (47.9)
0.51 (62.5) 0.56 (49.4) 0.57 (48.7)
0.49 (66.8) 0.61 (51.7) 0.49 (47.3)
0.57 (66.1) 0.59 (50.0) 0.59 (48.6)
0.49 (48.2) 0.66 (57.5)
0.49 (48) 0.63 (56.4)
0.48 (48.3) 0.69 (58.6)
0.42 (49.1) 0.65 (58.0)
0.48 (48.6) 0.69 (57.4)
0.56 (47.1) 0.63 (57.5)
0.62 (50.6)
0.67 (50.1)
0.55 (51.2)
0.55 (48.3)
0.73 (52.0)
0.56 (51.8)
0.54 (59.0) 0.48 (55.8) 0.96 (86.7)
0.51 (57.6) 0.52 (57.4) 0.95 (86.2)
0.56 (60.5) 0.43 (54.3) 0.97 (87.4)
0.40 (58.7) 0.49 (58.0) 0.97 (85.5)
0.64 (58.7) 0.48 (54.0) 0.94 (83.6)
0.56 (59.6) 0.47 (55.7) 0.92 (91.1)
0.42 (48.4) 0.59 (52.9) 0.60 (51.8)
0.48 (47.3) 0.66 (54.3) 0.59 (53.9)
0.37 (49.5) 0.48 (51.4) 0.50 (49.8)
0.34 (41.6) 0.53 (52.0) 0.61 (54.3)
0.44 (50.7) 0.56 (49.3) 0.47 (48.3)
0.51 (52.9b) 0.68 (57.5) 0.69 (53.2)
0.62 (49.0)
0.64 (47.8)
0.59 (50.2)
0.67 (49.4)
0.52 (45.0)
0.68 (52.9)
0.68 (62.7) 0.42 (53.0)
0.66 (64.2) 0.43 (55.0)
0.69 (61.2) 0.40 (51.0)
0.60 (62.1) 0.54 (54.6)
0.78 (64.8) 0.25 (49.0)
0.64 (61.1) 0.41 (55.7)
p u b l i c h e a l t h 1 3 0 ( 2 0 1 6 ) 9 1 e9 4
Core items 1-RD What is the main type of housing in your neighbourhood? 2-AD Many shops, stores, markets or other places to buy things I need are within easy walking distance of my home 3-AD It is within a 10e15-min walk to a transit stop from my home 4-NI There are sidewalks on most of the streets in my neighbourhood 5-NI There are facilities to cycle in or near my neighbourhood, such as shared-use paths for cycles and pedestrians 6-AD My neighbourhood has several free or low-cost recreation facilities 7-NS The crime rate in my neighbourhood makes it unsafe to go on walks at night Recommended items 8-NS There is so much traffic on the streets that it makes it difficult or unpleasant to walk in my neighbourhood 9-SE I see many people being physically active in my neighbourhood 10-AQ There are many interesting things to look at while walking in my neighbourhood 11-HV How many motor vehicles in working order are there at your household? Optional items 12-SC There are many four-way intersections in my neighbourhood 13-NI The sidewalks in my neighbourhood are well maintained and not obstructed 14-NI Places for cycling in and around my neighbourhood are well maintained and not obstructed 15-NS There is so much traffic on the streets that it makes it difficult or unpleasant to ride a bicycle in my neighbourhood 16-NS The crime rate in my neighbourhood makes it unsafe to go on walks during the day 17-AD There are many places to go within easy walking distance of my home
Sex Boys (n ¼ 427)
Domains of built environmental features: RD, residential density; AD, access to destinations; NI, neighbourhood infrastructure; NS, neighbourhood safety; SE, social environment; AQ, aesthetic qualities; HV, household motor vehicles; SC, street connectivity. P < 0.05 for the difference in percentage agreement between sexes, and between primary and senior high schools.
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In summary, the testeretest reliability of PANES-CHN was found to be moderate and generally acceptable in Chinese students aged 10e18 years. It provides an easy, convenient and reliable instrument to investigate the relationship between features of the built environment and physical activity in Chinese adolescents.
Author statements Acknowledgement The authors wish to thank Dr Xin Hong, Huafeng Yang, Xupeng Chen, Shengxiang Qi, Chenchen Wang, Zhenni Deng and Wenjie Chu for their assistance in data collection, and all the participating schools.
Ethical approval The Academic and Ethical Committee of Nanjing Municipal Centre for Disease Control and Prevention reviewed and approved this study in accordance with the internationally agreed ethical principles for medical research involving human subjects.
Funding The study was supported by Nanjing Medical Science and Technique Development Foundation (ZDX12019) and the Young Medical Experts Project of Nanjing Medical Science and Technique Development Foundation (QRX11038), China. Neville Owen is supported by a National Health and Medical Research Council of Australia (NHMRC) Program Grant [#569940], a Senior Principal Research Fellowship [NHMRC #1003960] and the Victorian Government's Operational Infrastructure Fund.
Competing interests None declared.
references
1. World Health Organization. Physical activity: global strategy on diet, physical activity and health. Geneva: WHO. Available at: http://www.who.int/dietphysicalactivity/pa/en/index.html; 2004 (last accessed 17 August 2013). 2. US Department of Health and Human Services. Physical Activity Guidelines for Americans Midcourse Report: strategies to increase physical activity among youth. Washington, D.C.: US Department of Health and Human Services. Available at: http://www.health.gov/paguidelines; 2012 (last accessed 17 August 2013). 3. Humpel N, Owen N, Leslie E. Environmental factors associated with adult's participation in physical activity e a review. Am J Prev Med 2002;22:188e99. 4. Mota J, Almeida M, Santos P, Ribeiro JC. Perceived neighborhood environment and physical activity in adolescents. Prev Med 2005;14:834e6. 5. Oyeyemi AL, Ishaku CM, Deforche B, Oyeyemi AY, De Bourdeaudhuij I, Van Dyck D. Perception of built environmental factors and physical activity among adolescents in Nigeria. Int J Behav Nutr Phys Act 2014;11:56. 6. Xu F, Li J, Liang Y, Wang Z, Hong X, Ware RS, et al. Associations of residential density with adolescents' physical activity in a rapidly urbanizing area of Mainland China. J Urban Health 2010;87:44e53. 7. International Physical Activity Prevalence Study. Selfadministered environmental module. Available at: http://www. drjamessallis.sdsu.edu/Documents/IPAQIPS.pdf; 2002 (last accessed 17 October 2012). 8. Oyeyemi AL, Adegoke BO, Oyeyemi AY, Fatudimu BM. Testeretest reliability of IPAQ environmental-module in an African population. Int J Behav Nutr Phys Act 2008;5:38. 9. Alexander A, Bergman P, Hagstromer M, Sjostron M. IPAQ environmental module; reliability testing. J Public Health 2006;14:76e80. 10. Sallis JF, Kerr J, Carlson JA, Norman GJ, Saelens BE, Durant N, et al. Evaluating a brief self-report measure of neighborhood environments for physical activity research and surveillance: Physical Activity Neighborhood Environment Scale (PANES). J Phys Act Health 2010;7:533e40.
Available online at www.sciencedirect.com
Public Health journal homepage: www.elsevier.com/puhe
Short Communication
Testeretest reliability of the Physical Activity Neighborhood Environment Scale among school students in China F. Xu a,b,*, E. Leslie c, Z. Wang a, H. Zhou a, N. Owen d,e a
Nanjing Municipal Centre for Disease Control and Prevention, Nanjing, China School of Public Health, Nanjing Medical University, Nanjing, China c School of Medicine, Flinders University, Adelaide, Australia d Behavioural Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia e School of Population Health, The University of Queensland, Brisbane, Australia b
article info Article history: Received 27 October 2014 Received in revised form 26 June 2015 Accepted 1 October 2015 Available online 1 November 2015
Introduction It has been well documented that regular physical activity (PA) has important benefits for health.1,2 A PA-friendly built environment has emerged as a promising approach for PA promotion at population level.2e6 It is of great importance to use reliable instruments to assess the attributes of the built environment in order to investigate its impact on PA among people. Geographic Information Systems (GIS) have been used to measure built environment correlates objectively for public health purposes. However, the high cost and complicated technical support of GIS limit wide use. Therefore, a reliable and easily applicable instrument is needed to assess the attributes of the built environment at population level. The
environmental module developed for the International Physical Activity Prevalence Study provides a short-form environmental measure, the Physical Activity Neighborhood Environment Scale (PANES) (formerly named the International Physical Activity Questionnaire Environmental Module), that can meet this need.7 PANES has been shown to have good testeretest reliability in Swedish, Nigerian and USA adult samples, and is usually adaptable for use in international studies with single items.8e10 Considering the rapid urbanization and the increasing prevalence of physical inactivity among adolescents in Mainland China (i.e. average sedentary behaviour time is approximately 70 h/week among Chinese school students),5 it is of importance to identify factors of the built environment that may influence PA in Chinese adolescents. To examine the reliability of a Chinese version of PANES (PANES-CHN) among urban Chinese school students, this testeretest study was conducted in urban areas of Nanjing, one of the largest cities in eastern China. The first survey was conducted in early May 2013, and the retest survey was conducted 7 days later. Written informed consent forms were obtained from participating schools, students and parents/ guardians. The Academic and Ethical Committee of Nanjing Municipal Centre for Disease Control and Prevention reviewed and approved this study. The participants were selected from Grades 4 to 12 (approximately 10e18 years old) from primary and high schools using a multistage sampling method. First, two urban
* Corresponding author. Nanjing Municipal Centre for Disease Control and Prevention, 2, Zizhulin, Nanjing 210003, PR China. Tel.: þ86 25 8353 8305. E-mail address: [email protected] (F. Xu). http://dx.doi.org/10.1016/j.puhe.2015.10.001 0033-3506/© 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
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districts were selected at random. Next, one school was chosen at random from all primary, junior and senior high schools, respectively, within each selected district. Next, one class was chosen at random from each grade within each selected school. All students within the selected classes were eligible participants. Based on the overall sample size in previous studies (ranging from 98 to 298),7e9 the sample size in this study was estimated to be approximately 270 for each type of school (90 for each grade), and 810 in total, to guarantee sufficient statistical power in each type of school (primary, junior and senior high school). The final number of eligible participants was 884 based on this sampling approach. PANES-CHN was translated from the original English PANES through a strict and standardized procedure, including translation and back-translation, pilot study using initial PANES-CHN, and panel review and assessment. In China, apartments have been built according to regulations as: (1) seven or fewer storeys, usually without elevators; or (2) eight or more storeys, compulsorily with elevators. Thus, the specific response options for Item 1 (main type of housing) were modified to include these options. The full PANES-CHN is available on request from the corresponding author. PANES consisted of 17 items regarding attributes of the local built environment, with the ‘neighbourhood’ specifically defined as a 10e15-min walk from home. These 17 questions were categorized into three subgroups: seven core items (consisting of residential density, access to destinations, neighbourhood infrastructure and neighbourhood safety), four recommended items (comprising neighbourhood safety, social environment, aesthetic qualities and household motor vehicle) and six optional items (including access to destinations, neighbourhood infrastructure, street connectivity and neighbourhood safety). Four-point Likert response scales ranging from ‘strongly disagree’ to ‘strongly agree’, as well as ‘don't know’ or ‘doesn't apply’ options, were used for 15 questions, with two exceptions: Item 1, which asks about the main type of housing in the neighbourhood (to assess residential density); and Item 11, which asks for the number of household motor vehicles (numerical value; ‘don't know/not sure’). The testeretest reliability for each environmental attribute was estimated using intraclass correlation coefficient (ICC) and percentage agreement. Differences in percentage agreement between the sexes and school types were examined using Chi-squared analysis.
Reliability of PANES-CHN Of the 884 eligible participants, 847 were recruited for the firstround survey (participation rate 95.8%). One week later, all 847 students completed the retest survey (follow-up rate 100%). The mean age of participants was 14.2 [standard deviation (SD) 2.6] years [boys vs girls: 14.0 (SD 2.5) years vs 14.4 (2.7) years]. There were 427 (50.4%) boys, 269 (31.8%) primary school students, 298 (35.2%) junior high school students and 280 (33.1%) senior high school students. Table 1 shows the ICC values and percentage agreement for each built environment item by sex and school type. Overall, the ICC ranged from 0.49 (Item 6, access to
destinations) to 0.84 (Item 1, residential density) for the core items, from 0.48 (Item 10, aesthetic qualities) to 0.62 (Item 8, neighbourhood safety) for the recommended items, and from 0.42 (Items 12 and 17, street connectivity and access to destinations, respectively; the lowest ICC value among all 17 items) to 0.68 (Item 16, neighbourhood safety) for optional items, while the item regarding the number of household motor vehicles had the highest ICC value of 0.96. Among the 17 items, only Item 1 was found to be significantly different in terms of percentage agreement between boys and girls (c2 ¼ 7.51, P < 0.05), and Item 12 differed significantly between primary schools and senior high schools (c2 ¼ 7.03, P < 0.05). Generally, no differences in PANES-CHN were found between the sexes and school types. To the authors' knowledge, this is the first study to assess the testeretest reliability of PANES in primary and high school students. Moderate reliability was found for the majority of PANES-CHN items, and substantial reliability was found for a few PANES-CHN among the students, regardless of sex and school type, suggesting that PANES-CHN items may be acceptable for use in Chinese school students. Although the participants were younger than their counterparts in previous studies, the finding of moderate reliability for PANES-CHN items was generally similar to adult studies.8e10 Compared with findings among adults, five of the seven core items had lower ICC values and two had higher ICC values. For the recommended items, two of the four items had lower ICC values and two had higher ICC values in the study population.8e10 The highest ICC and percentage agreement values were found for Items 1 (main type of neighbourhood housing) and 11 (number of household motor vehicles), which was similar to the results found among adults.8e10 However, the lowest ICC values (0.42) were seen for Items 12 (street connectivity) and 17 (access to destinations) (both optional items), which was in contrast to the findings from adult studies.8e10 Adolescents experience body growth, including physical and intellectual development; and gradual adaptation to social, cultural and environmental contexts. They may have different sensitivity and judgement ability in relation to their neighbourhood environment compared with adults. For example, it is easier for adolescents to report objective counts or descriptions (i.e. number of household motor vehicles) than subjective ratings (i.e. easy walking distance of home). China, the most populous society in the world, may have different social and cultural contexts of the neighbourhood environment compared with other societies. These issues may, at least in part, explain the differences in ICC for several PANES items between Chinese adolescents and adults in other countries. Several factors influence testeretest reliability of an instrument. Time between survey administrations may affect the reliability of an instrument's testeretest. In this study, the interval between the two surveys was exactly 7 days, which would warrant minimal change in neighbourhood built environment attributes. Additionally, some subjectively perceived items, such as safety, may be influenced by occasional events; however, during the survey period, no notable safety events were reported by any local media coverage.
Table 1 e Intraclass correlation coefficients (ICC) and percentage agreement between two tests among students by sex and school type. Environmental variablesa
ICC (percentage agreement between two tests)b Overall (n ¼ 847)
a
b
School Girls (n ¼ 420)
Primary (n ¼ 269)
Junior high (n ¼ 298)
Senior high (n ¼ 280)
0.84 (85.7) 0.53 (65.3)
0.82 (82.4) 0.51 (63.7)
0.86 (89.0b) 0.56 (66.9)
0.80 (82.9) 0.46 (64.7)
0.85 (85.2) 0.53 (65.8)
0.87 (88.9) 0.62 (65.4)
0.52 (65.2) 0.58 (50.4) 0.55 (48.1)
0.53 (63.9) 0.58 (49.9) 0.58 (48.2)
0.49 (66.4) 0.58 (51.0) 0.51 (47.9)
0.51 (62.5) 0.56 (49.4) 0.57 (48.7)
0.49 (66.8) 0.61 (51.7) 0.49 (47.3)
0.57 (66.1) 0.59 (50.0) 0.59 (48.6)
0.49 (48.2) 0.66 (57.5)
0.49 (48) 0.63 (56.4)
0.48 (48.3) 0.69 (58.6)
0.42 (49.1) 0.65 (58.0)
0.48 (48.6) 0.69 (57.4)
0.56 (47.1) 0.63 (57.5)
0.62 (50.6)
0.67 (50.1)
0.55 (51.2)
0.55 (48.3)
0.73 (52.0)
0.56 (51.8)
0.54 (59.0) 0.48 (55.8) 0.96 (86.7)
0.51 (57.6) 0.52 (57.4) 0.95 (86.2)
0.56 (60.5) 0.43 (54.3) 0.97 (87.4)
0.40 (58.7) 0.49 (58.0) 0.97 (85.5)
0.64 (58.7) 0.48 (54.0) 0.94 (83.6)
0.56 (59.6) 0.47 (55.7) 0.92 (91.1)
0.42 (48.4) 0.59 (52.9) 0.60 (51.8)
0.48 (47.3) 0.66 (54.3) 0.59 (53.9)
0.37 (49.5) 0.48 (51.4) 0.50 (49.8)
0.34 (41.6) 0.53 (52.0) 0.61 (54.3)
0.44 (50.7) 0.56 (49.3) 0.47 (48.3)
0.51 (52.9b) 0.68 (57.5) 0.69 (53.2)
0.62 (49.0)
0.64 (47.8)
0.59 (50.2)
0.67 (49.4)
0.52 (45.0)
0.68 (52.9)
0.68 (62.7) 0.42 (53.0)
0.66 (64.2) 0.43 (55.0)
0.69 (61.2) 0.40 (51.0)
0.60 (62.1) 0.54 (54.6)
0.78 (64.8) 0.25 (49.0)
0.64 (61.1) 0.41 (55.7)
p u b l i c h e a l t h 1 3 0 ( 2 0 1 6 ) 9 1 e9 4
Core items 1-RD What is the main type of housing in your neighbourhood? 2-AD Many shops, stores, markets or other places to buy things I need are within easy walking distance of my home 3-AD It is within a 10e15-min walk to a transit stop from my home 4-NI There are sidewalks on most of the streets in my neighbourhood 5-NI There are facilities to cycle in or near my neighbourhood, such as shared-use paths for cycles and pedestrians 6-AD My neighbourhood has several free or low-cost recreation facilities 7-NS The crime rate in my neighbourhood makes it unsafe to go on walks at night Recommended items 8-NS There is so much traffic on the streets that it makes it difficult or unpleasant to walk in my neighbourhood 9-SE I see many people being physically active in my neighbourhood 10-AQ There are many interesting things to look at while walking in my neighbourhood 11-HV How many motor vehicles in working order are there at your household? Optional items 12-SC There are many four-way intersections in my neighbourhood 13-NI The sidewalks in my neighbourhood are well maintained and not obstructed 14-NI Places for cycling in and around my neighbourhood are well maintained and not obstructed 15-NS There is so much traffic on the streets that it makes it difficult or unpleasant to ride a bicycle in my neighbourhood 16-NS The crime rate in my neighbourhood makes it unsafe to go on walks during the day 17-AD There are many places to go within easy walking distance of my home
Sex Boys (n ¼ 427)
Domains of built environmental features: RD, residential density; AD, access to destinations; NI, neighbourhood infrastructure; NS, neighbourhood safety; SE, social environment; AQ, aesthetic qualities; HV, household motor vehicles; SC, street connectivity. P < 0.05 for the difference in percentage agreement between sexes, and between primary and senior high schools.
93
94
p u b l i c h e a l t h 1 3 0 ( 2 0 1 6 ) 9 1 e9 4
In summary, the testeretest reliability of PANES-CHN was found to be moderate and generally acceptable in Chinese students aged 10e18 years. It provides an easy, convenient and reliable instrument to investigate the relationship between features of the built environment and physical activity in Chinese adolescents.
Author statements Acknowledgement The authors wish to thank Dr Xin Hong, Huafeng Yang, Xupeng Chen, Shengxiang Qi, Chenchen Wang, Zhenni Deng and Wenjie Chu for their assistance in data collection, and all the participating schools.
Ethical approval The Academic and Ethical Committee of Nanjing Municipal Centre for Disease Control and Prevention reviewed and approved this study in accordance with the internationally agreed ethical principles for medical research involving human subjects.
Funding The study was supported by Nanjing Medical Science and Technique Development Foundation (ZDX12019) and the Young Medical Experts Project of Nanjing Medical Science and Technique Development Foundation (QRX11038), China. Neville Owen is supported by a National Health and Medical Research Council of Australia (NHMRC) Program Grant [#569940], a Senior Principal Research Fellowship [NHMRC #1003960] and the Victorian Government's Operational Infrastructure Fund.
Competing interests None declared.
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