Purpose: Only international studies can provide the full variability of built environments and accurately estimate effect sizes of relations between contrasting environments and health-related outcomes. The aims of the International Physical Activity and Environment Study of Adolescents (IPEN Adolescent) are to estimate the strength, shape, and generalizability of associations of the community environment (geographic information systems (GIS)-based and self-reported) with physical activity and sedentary behavior (accelerometer-measured and self-reported) and weight status (normal/overweight/obese).

Methods: The IPEN Adolescent observational, cross-sectional, multi-country study involved recruiting adolescent participants (ages 11-19 yrs) and one parent/guardian from neighborhoods selected to ensure wide variations in walkability and socioeconomic status using common protocols and measures. Fifteen geographically, economically, and culturally diverse countries, from six continents, participated: Australia, Bangladesh, Belgium, Brazil, Czech Republic, Denmark, Hong Kong SAR, India, Israel, Malaysia, New Zealand, Nigeria, Portugal, Spain and USA. Countries provided survey and accelerometer data (15 countries), GIS data (11), global positioning system data (10), and pedestrian environment audit data (8).

Results: A sample of n=6,950 (52.6% female; mean age=14.5, SD=1.7) adolescents provided survey data, n=4,852 had 4 or more 8+hour valid days of accelerometer data, and n=5,473 had GIS measures. Physical activity and sedentary behaviour were measured by waist-worn ActiGraph accelerometers and self-reports, and body mass index was used to categorise weight status.

Conclusions: The IPEN Adolescent study will use the results to advance the science of environmental correlates of physical activity, sedentary behavior, and weight status, with the ultimate goal to stimulate and guide actions to create more activity-supportive environments worldwide.

The present study was developed within the framework of the IPEN (International Physical Activity and the Environment Network) Adolescent project in five cities: Melbourne (Australia), Ghent (Belgium), Curitiba (Brazil), Hong Kong (China), and Valencia (Spain). The main aim was to assess inter-rater reliability of the Microscale Audit of Pedestrian Streetscapes, Global version (MAPS-Global), comparing on-street and online observation methods in five countries with varying levels of walkability. Data were collected along walking routes from residential starting points toward commercial clusters. Target locations were selected in each city using a geographically stratified sampling design to ensure representation of neighborhoods varying in walkability and socio-economic status. To select high -versus low- walkable neighborhoods, all cities used a GIS-derived macro-level walkability index based on net residential, intersection density, and mixed land use. In-person on the street and online using Google Streetview audits were carried out by two independent trained raters. The final sample included 349 routes, 1228 street segments, 799 crossings, and 16 cul-de-sacs. Inter-rater reliability analyses were performed using Kappa or ICC statistics. Overall mean assessment times were the same for on-street and online evaluations (22±12 minutes). Overall scores for each section (route, segment, crossing) showed good to excellent reliability (ICCs: 0.813, 0.929 and 0.885, respectively). The MAPS-Global overall grand score had similar mean values for the on-street and online raters and demonstrated good to excellent reliability (ICC: 0.861). Considering good inter-rater reliability, MAPS-Global is a feasible and reliable instrument that can be used both on-street and online to analyze microscale environmental characteristics in diverse urban settings.

Purpose: The IPEN (International Physical Activity and Environment Network) Adolescent study was conducted using common study protocols to document the associations of perceived neighborhood environment attributes with adolescents’ physical activity and overweight/obesity across 15 countries. As countries did not use identical versions of the Neighborhood Environment Walkability Scale for Youth (NEWS-Y) to measure perceived neighborhood environment attributes, we developed a measurement model and scoring protocol for NEWS-Y items common to all IPEN Adolescent countries (NEWS-Y-IPEN). We also examined the construct validity of the NEWS-Y-IPEN subscales in relation to neighborhood-level socio-economic status and walkability.

Methods: Adolescents and one of their parents (N = 5,714 dyads) were recruited from neighborhoods varying in walkability and socio-economic status. To measure perceived neighborhood environment, 14 countries administered the NEWS-Y to parents and one country to adolescents. Comparable country-specific measurement models of the NEWS-Y-IPEN were derived using confirmatory factor analysis. To examine the construct validity of NEWS-Y-IPEN subscales, we estimated their associations with neighborhood-level walkability and socio-economic status.

Results: Country-specific measurement models of the factor-analyzable NEWS-Y-IPEN items provided acceptable levels of fit to the data and shared the same factorial structure with five latent factors: Accessibility and walking facilities; Traffic safety; Pedestrian infrastructure and safety; Safety from crime; and Aesthetics. Associations between NEWS-Y-IPEN subscales and neighborhood-level walkability and socio-economic status provided strong evidence of construct validity. Our study suggests that the NEWS-Y-IPEN possesses good factorial and construct validity.

Conclusions: Future studies employing NEWS-Y-IPEN should use the proposed scoring protocol to facilitate cross-study comparisons and interpretation of findings.