E

Disparities Tables1

The following summarizes the findings for the number of tools and methods identified by population of risk or social influence by each of the five environments in the National Collaborative on Childhood Obesity Research Registry (NCCOR-R).

PHYSICAL ACTIVITY ENVIRONMENT

NCCOR-R housed N=290 tools and methods of the physical activity environment at the time of this review. After applying exclusionary criteria,2 removing duplicate tools and methods relevant to other target environments, and assessing populations at risk, the Committee identified 65 tools and methods (see Table E-1). About half of the tools and methods (N=36) were focused at the community level, and the rest were individual level (N=29). Four tools and methods were designed for populations at risk for disparities, specifically African Americans (N=1), Hispanics (N=2), and American Indian and Alaskan Natives (N=1). None of the tools or methods were designed specifically for Asian or Hawaiian or Pacific Islanders. One measurement tool targeted multiple populations at risk for disparities, and the remaining 60 tools and methods related to physical activity environment were inclusive of majority white and various other multiethnic populations at risk for disparities. Six tools and methods specifically targeted females, and none addressed only males. For 12 tools and methods, the database included no information on sex specificity, and the remaining tools and methods cited use with both males and females (N=47). Of the 46 tools and methods identifying geographic location, none were specific to rural settings; instead the majority cited use in urban settings (N=37) or both urban and rural settings (N=10). Disability was the focus of only one measurement tool or method (Spivock et al., 2007); sexual identity was not cited as a reported focus of any tools and methods.

A majority of tools and methods included variables that address living and working conditions (N=55) generally defined by aspects of the built environment, access, and availability to safe places to be

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1 This summary does not include references. Citations to support statements made herein are given in the body of the report.

2 Exclusionary criteria for identifying tools and methods within NCCOR-R targeting populations with health disparities included individual tools and methods of dietary intake or physical activity (e.g., 24-hour dietary recalls, food frequency tools and methods, or actigraph), and surveillance tools and methods because Accelerating Progress in Obesity Prevention report (IOM, 2012) recommendations focus on environmental and policy changes.



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E Disparities Tables 1 T he following summarizes the findings for the number of tools and methods identified by population of risk or social influence by each of the five environments in the National Collaborative on Childhood Obesity Research Registry (NCCOR-R). PHYSICAL ACTIVITY ENVIRONMENT NCCOR-R housed N=290 tools and methods of the physical activity environment at the time of this review. After applying exclusionary criteria,2 removing duplicate tools and methods relevant to other target environments, and assessing populations at risk, the Committee identified 65 tools and methods (see Table E-1). About half of the tools and methods (N=36) were focused at the community level, and the rest were individual level (N=29). Four tools and methods were designed for populations at risk for disparities, specifically African Americans (N=1), Hispanics (N=2), and American Indian and Alaskan Natives (N=1). None of the tools or methods were designed specifically for Asian or Hawaiian or Pacific Islanders. One measurement tool targeted multiple populations at risk for disparities, and the remain- ing 60 tools and methods related to physical activity environment were inclusive of majority white and various other multiethnic populations at risk for disparities. Six tools and methods specifically targeted females, and none addressed only males. For 12 tools and methods, the database included no information on sex specificity, and the remaining tools and methods cited use with both males and females (N=47). Of the 46 tools and methods identifying geographic location, none were specific to rural settings; instead the majority cited use in urban settings (N=37) or both urban and rural settings (N=10). Disability was the focus of only one measurement tool or method (Spivock et al., 2007); sexual identity was not cited as a reported focus of any tools and methods. A majority of tools and methods included variables that address living and working conditions (N=55) generally defined by aspects of the built environment, access, and availability to safe places to be 1  Thissummary does not include references. Citations to support statements made herein are given in the body of the report. 2  Exclusionary criteria for identifying tools and methods within NCCOR-R targeting populations with health disparities included individual tools and methods of dietary intake or physical activity (e.g., 24-hour dietary recalls, food frequency tools and methods, or actigraph), and surveillance tools and methods because Accelerating Progress in Obesity Prevention report (IOM, 2012) recommendations focus on environ- mental and policy changes. 331

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active, and other environmental aesthetics. Sociocultural influences were primarily designated as study covariates. Socioeconomic influences identified in NCCOR-R included covariates including races and socioeconomic status (SES) for N=38, and relevant variables of interest; instead relevant variables of inter- est; were frequently included as covariates in studies using the target tools and methods (N=55). Wolch and colleagues (2011) reported the only tool or method that captured any length of exposure to disadvan- taged conditions addressed a time frame of 8 years. A majority of the tools and methods reviewed use interviews, surveys, or questionnaires, either investigator- or self-administered (N=40). Observational instruments were less common (N=7), and only Davison (2011) and Israel et al. (2006) used focus group methods. The use of geographic information system (GIS) methods accounted for N=21 cited tools and methods. Of the 58 tools and methods report- ing sample size, N=8 cited use with fewer than 100 subjects, N=19 cited use with 100 to 500 subjects, and N=31 cited use with greater than 500 subjects. Finally, psychometric properties of either reliability or validity were not reported for 22 of the 65 tools and methods. Of those with reported psychometric data, N=18 reported both reliability and validity, N=9 reported only reliability, and N=16 reported only valid- ity. Of the N=27 tools and methods for which some form of reliability was reported, methods included test-retest (N=17), internal consistency (N=8), inter-rater reliability (N=6), and inter-instrumentation (N=1). Validity3 was reported for 31 tools and methods and included construct validity (N=13 tools and methods), concurrent (N=7), criterion (N=8), predictive (N=5), content (N=1), convergent (N=1), discrim- inant (N=1), and face validity (N=1 each). FOOD AND BEVERAGE ENVIRONMENT A search of the food environment in NCCOR-R yielded 283 tools and methods. After applying exclusionary criteria, removing duplicate tools and methods relevant to other target environments, and assessing populations at risk, the Committee identified 51 tools and methods for inclusion in Table E-2. More than two-thirds (N=34) are focused at the community level, and one-third are at the individual level (N=17). Fourteen tools and methods were designed specifically for populations at risk for disparities, with 13 focused on African Americans and 1 focused on Hispanics. Two tools and methods were multi­ thnic e (e.g., addressed both African American and Hispanics), while 31 tools and methods were for whites along with multiple other populations at risk. Among tools and methods specific to sex, four were used spe- cifically with females, while one tool or method was used with only males. Fourteen tools and methods cited use with both male and female populations, while 32 tools and methods did not specify sex. Of the 38 tools and methods identifying geographic focus, only one specified use with a rural setting, while the majority (N=30) were used in urban settings. Seven tools and methods cited use in both rural and urban locations. There were no tools and methods designed for populations with disabilities or sexual identity/ preference. This review of dimensions of disparities revealed that 47 tools and methods included variables rel- evant to living and working conditions and measuring their access to and availability of foods and quality of foods. Sociocultural influences were included in 2 measurement tools or research methodology, while socioeconomic influences were described in 12 tools and methods. Sociocultural covariates were described 3  Definitions for the various types of validity can be located at http://nccor.org/downloads/NCCOR%20MPR%20Report%20Final.pdf (accessed November 12, 2013). 332 Evaluating Obesity Prevention Efforts

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in N=7 while socioeconomic covariates were described in N=29. N=41 studies listed socioeconomic relat- ed variables. Tools and methods of life course exposure were not included. The majority of tools and methods were interviews, surveys, or questionnaires, either administered by researchers or self-administered (N=28); few observational instruments (N=5) and focus group meth- ods (N=4) were used. The use of GIS methods accounted for N=10 cited tools and methods. Of the 39 tools and methods reporting sample size, N=4 cited use with fewer than 100 subjects, N=22 were used with 100 to 500 subjects, and N=13 were used for greater than 500 subjects. Of the 51 tools and meth- ods related to food and beverage environment in NCCOR-R, 33 did not include psychometric properties. Of those reporting psychometric properties of data generated by the tool or method, N=9 reported find- ings for both reliability and validity, N=8 reported only reliability, and 1 cited only tools and methods of validity. Of the tools and methods in which some form of reliability was reported, methods included test-retest (N=7), internal consistency (N=9), and inter-rater reliability (N=8). Types of validity testing included construct validity (N=6), and one each for criterion (N=1), predictive (N=1), convergent (N=1), and face validity (N=1). MESSAGE ENVIRONMENT A search of NCCOR-R for media and message environment produced 95 tools and methods. After applying exclusionary criteria, removing duplicate tools and methods, and targeting the search toward populations of interest, the Committee included 8 tools and methods in Table E-3. Of these, five were focused at the community level and three at the individual level. Four tools and methods were designed specifically for populations at risk for disparities, including three focused on African Americans and one on Hispanics. The remaining three tools and methods were designed for the majority white population but also included specific ethnic populations at risk for disparities; one tool/method did not report eth- nicity. All 8 tools and methods were used with urban populations. None of the tools or methods were focused on sex, persons with disabilities, or sexual identity. Six tools and methods addressed living and working conditions. Ayala and colleagues (2007) described the only tool or method to include sociocul- tural content related to eating and socioeconomic content related to purchasing. None of the tools and methods addressed duration or intensity of exposure to media. Interviews, surveys, or questionnaires, either administered by researchers or self-administered, account- ed for seven tools and methods; one instrument was observational. All tools and methods reported sample size: N=2 tool/method was used with fewer than 100 subjects, N=3 with 100 to 500 subjects, and N=3 tools and methods were used with more than 500 subjects. Psychometric properties of reliability or validity were not available through NCCOR-R for three of the eight tools and methods. Of those reporting psychometric data, two reported findings for both reliability and validity, and three reported only reliability. Reliability methods included test-retest (N=2), internal consistency (N=1), and inter-rater reliability (N=2). Criterion validity was reported on two tools and methods. No other validity information was provided. HEALTH CARE/WORKSITE ENVIRONMENT NCCOR-R contained 14 tools and methods regarding the health care/worksite environment. After applying exclusionary criteria, removing duplicate tools and methods, and targeting the search toward populations of interest, the Committee included only two tools and methods in Table E-4. None of these Appendix E 333

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tools and methods were designed specifically for populations at risk for disparities. One tool/method was focused at the community level, and one at the individual level. Both addressed urban settings. Neither addressed specific populations related to sex, disability, or sexual identity. A review of tools and methods targeting or addressing dimensions of disparities revealed that both tools and methods addressed living and working conditions; variables of sociocultural or socioeconomic influence or life course exposure were not described. One tool/method was a telephone survey; the other was a self-administered question- naire. One tool/method reported use with a sample size of fewer than 100 subjects; one was used with greater than 500 subjects. Psychometric qualities were not reported for either tool or method. SCHOOL AND CHILD CARE ENVIRONMENT NCCOR-R yielded 364 tools and methods of school and early child care environments. After apply- ing exclusionary criteria, removing duplicate tools and methods relevant to other target environments, and assessing by populations at risk, the Committee identified 48 tools and methods for inclusion in Table E-5. Of these, N=38 reflected the individual level, N=3 organizational, N=5 community, and N=2 policy level. Twenty-one tools and methods were designed specifically for populations at risk for disparities, all of which were derived from one study (The Minnesota Girls’ Health Enrichment Multi-Site Studies [GEMS] pilot study) that focused on African American girls (Story et al., 2003). Two tools and methods addressed American Indians, and two were developed for Asian Americans, and one addressed both the African American and Hispanic populations. No other tools and methods were identified as targeting any other populations at risk for disparities. Twenty-one of the tools and methods described were population- wide, addressing multiple ethnic minorities and the majority white population. In addition to the GEMS tools and methods (N=21), 3 studies focused only on women or girls; 14 were used with populations of males and females. With regard to geographic focus, 16 tools and methods cited use with urban popu- lations; none included use with rural or combined rural and urban populations. None of the tools and methods specifically addressed sexual identity or disabilities associated with the school and child care environment. Variables reflecting living and working conditions were included in 39 tools and methods (of which 21 were from the GEMS study). Sociocultural variables were included in three tools and methods plus GEMS, while socioeconomic variables were not included in any tools and methods. As noted in previous environments, variables of interest were again described as covariates in studies that used the target tools and methods (sociocultural N=27, socioeconomic N=15). N=21 plus GEMS studies included socioeco- nomic-related variables. None of the tools and methods addressed length of exposure to disadvantaged conditions. Interviews, surveys, or questionnaires, either administered by researchers or self-administered, accounted for N=43 tools and methods (including all GEMS tools and methods), while two instruments were observational. Three tools and methods used GIS methods. Of the tools and methods reporting sample size, N=7 tools and methods plus GEMS were used with less than 100 subjects, N=7 were used for 100 to 500 subjects, and N=9 included more than 500 subjects. Psychometric properties of reliability or validity were not available for 14 tools and methods. Of those reporting psychometric data, 4 reported findings for both reliability and validity, N=7 + 21 GEMS reported only reliability, and N=3 cited valid- ity only. Of the tools and methods in which some form of reliability was reported, methods included 334 Evaluating Obesity Prevention Efforts

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test-retest (N=5), internal consistency (N=2 + 21 GEMS), and inter-rater reliability (N=4). Validity was reported as follows: face validity (N=1), constructive (N=1), concurrent (N=2), criterion (N=3), content (N=1), and predictive (N=2). OTHER LIMITATIONS Chapter 5 and this Appendix focus only on tools and methods available in the NCCOR-R and did not secure tools and methods located outside of NCCOR-R or in other tools and research methods data- bases. This review did not attempt to assess the tools and methods of the monitoring of implementation or quality of interventions as applied to cultural sensitivity on the part of organizations and practitioners. As mentioned previously, no other databases focus on measuring obesity and related environments, pro- grams, and systems and provide a good opportunity to compile existing tools and methods that could be used to assess progress with particular attention to disparities. In addition, NCCOR-R is an active data- base with tools and methods added on a continuing basis. Therefore, relevant tools and methods entered into NCCOR-R after the review may not have been captured. The search was conducted using multiple key terms and words as descriptors of targeted populations at risk and social influence. Although this was a comprehensive strategy, it is possible that the key terms did not identify all possible tools and methods. A detailed review of all of the content of NCCOR-R tools and methods was beyond the scope of this review. The review relied on the descriptive data provided by NCCOR-R and expert interpretation of these data to categorize the instruments. In doing so, potential inconsistencies in how constructs of inter- est were defined, inaccuracy in categorizing tools and methods, or omission of critical variables of inter- est could have crept into this report. NCCOR-R was designed to house tools and methods particularly relevant to childhood obesity, which may limit inclusion of relevant tools and methods beyond youth; however, many food and physical activity environmental tools and methods identified are not age-specific and were therefore included and apply to the adult population. This likely limited the library of tools and methods included in the worksite/health care environment. Despite these limitations, it is noteworthy that at the time of this review, 17 percent of the NCCOR-R tools and methods were for children ages 2-5 years, whereas 19 percent were for use only with adults. Finally, this review focused on the availability of tools and methods of disparity and equity, and not on factors defining their use, scale of measurement (absolute versus ratio), or interpretation. Measurement of health disparities and equity have additional implications for assessing indicators of health and social advantage/disadvantage and for comparing indi- cators across social strata (Braveman, 2012; Woolf and Braveman, 2011). These are conceptual and meth- odological issues that require careful consideration, are the subject of other reviews (Braveman, 2009), and will have some consideration in other chapters (Chapters 6, 7, and 8). REFERENCES Abarca, J., and S. Ramachandran. 2005. Using community indicators to assess nutrition in Arizona-Mexico border communities. Preventing Chronic Disease 2(1):A06. Adams, A., and R. Prince. 2010. Correlates of physical activity in young American Indian children: Lessons learned from the Wisconsin Nutrition and Growth Study. Journal of Public Health Management and Practice 16(5):394-400. Appendix E 335

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TABLE E-5 Continued Social determinants: Population at risk: living and working Level, purpose, description, race/ethnicity; sex; sexual conditions; sociocultural; sample size, psychometric identity; disability; socioeconomic; life course Tool/Method properties geographic location exposure Pathways Individual measure Race/ethnicity: AA, AI/ Living and working Knowledge, To evaluate effectiveness of AN, Hispanic, white conditions: NR Attitudes, and nutrition component for 4th-grade Sex: M/F Sociocultural: Covariate Behaviors (KAB) children in public schools Sexual identity: NR psychological factors Questionnaire Researcher-administered Disability: NR (e.g., self-efficacy, beliefs, (DeVault et al., N=20 4th-grade classes, 140 Geographic: Urban preferences), social influence 2009) students (e.g., parent modeling) Reliability – NR; Validity – NR Socioeconomic: Covariates – SES, race; Related variables – WIC/free/reduced school lunch program Life course exposure: NR Food Checklist for Individual level Race/ethnicity: AA, AI/ Living and working It’s All About Kids To evaluate effectiveness of AN, Hispanic, white conditions: NR Program nutrition component for 4th-grade Sex: M/F Sociocultural: Confidence to (DeVault et al., children in public schools Sexual identity: NR participate in PA; Covariates 2009) Items – NR; Disability: NR – knowledge, psychological researcher-administered Geographic: Urban factors (e.g., self-efficacy, N=20 4th-grade classes, 140 beliefs, preferences), social students influence (e.g., parent Reliability – NR; Validity – NR modeling) Socioeconomic: Covariates – SES, race; Related variables – psychological, social variables, WIC/free/reduced school lunch program Life course exposure: NR Shape Up Individual level Race/ethnicity: AA, AI/ Living and working Somerville Study Three school-based questionnaires AN, Hispanic, Asian, conditions: NR Physical Activity to assess (a) fruit/vegetable white Sociocultural: Covariates – Questionnaire for intake, (b) PA and television Sex: M/F social influence (e.g., parental Young Children (TV) viewing, and (c) perceived Sexual identity: NR modeling) (Economos et al., parental support for diet and PA Disability: NR Socioeconomic: Covariates – 2008) 6 items; phone, in-person Geographic: Urban SES, race; Related variables administration – income N=86 school children Life course exposure: NR Reliability – test-retest; Validity – concurrent 390 Evaluating Obesity Prevention Efforts

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TABLE E-5 Continued Social determinants: Population at risk: living and working Level, purpose, description, race/ethnicity; sex; sexual conditions; sociocultural; sample size, psychometric identity; disability; socioeconomic; life course Tool/Method properties geographic location exposure Modified “Fruits Individual level Race/ethnicity: AA, AI/ Living and working and Vegetables Three school-based questionnaires AN, Hispanic, Asian, conditions: NR You Ate to assess (a) fruit and vegetable white Sociocultural: Covariates – Yesterday” Survey intake, (b) PA and TV viewing, Sex: M/F social influence (e.g., parental for Shape Up and (c) perceived parental support Sexual identity: NR modeling) Somerville Study for diet and physical activity Disability: NR Socioeconomic: Covariates – (Economos et al., 4 items; phone, in-person Geographic: Urban SES, race; Related variables 2008) administration – income N=86 school children Life course exposure: NR Reliability – test-retest; Validity – criterion Parental Support Individual level Race/ethnicity: AA, AI/ Living and working Questionnaire Three school-based questionnaires AN, Hispanic, Asian, conditions: NR for Shape Up to assess (a) fruit and vegetable white Sociocultural: Perception of Somerville Study intake, (b) PA and TV viewing, Sex: M/F parental support for fruit (Economos et al., and (c) perceived parental support Sexual identity: NR and vegetables; Covariates – 2008) for diet and physical activity Disability: NR social influence (e.g., parental 3 items; phone, in-person Geographic: Urban modeling) administration Socioeconomic: Covariates – N=86 school children SES, race; Related variables Reliability – test-retest; Validity – income – NR Life course exposure: NR Healthy Individual level Race/ethnicity: AA, AI/ Living and working Eating, Active To assess attitudes and AN, Hispanic, Asian, conditions: Perceptions of Communities behaviors regarding school food white school food environment, (HEAC) Survey environments during spring 2006 Sex: M/F availability/access, facility for 7th and 9th 138 items; self-administered Sexual identity: NR adequacy/appeal Graders N=5,365 subjects 12-18 yrs old Disability: NR Sociocultural: Perception (Gosliner et al., Reliability – NR; Validity – NR Geographic: Urban of healthiness; Covariates 2011) – psychological factors (e.g., self-efficacy, beliefs, preferences) Socioeconomic: Related variables – low-income students Life course exposure: NR continued Appendix E 391

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TABLE E-5 Continued Social determinants: Population at risk: living and working Level, purpose, description, race/ethnicity; sex; sexual conditions; sociocultural; sample size, psychometric identity; disability; socioeconomic; life course Tool/Method properties geographic location exposure School Wellness Policy level Race/ethnicity: AA, Living and working Policies for School Wellness Policy Coding Hispanic, white conditions: Policies related to Post-Partum Tool used to assess the strength Sex: NR food and PA environment Adolescents and comprehensiveness of school Sexual identity: NR Sociocultural: NR (Haire-Joshu et al., district wellness policies from 251 Disability: NR Socioeconomic: Related 2011) schools attended by participating Geographic: Urban variables – WIC/free/reduced adolescent mothers school lunch program Items – NR; self-administered Life course exposure: NR questionnaire N=647 respondents from N=251 schools across 27 states Reliability – NR; Validity – NR Home Availability Individual level Race/ethnicity: AA, white Living and working and Accessibility Surveys of parents and children, Sex: NR conditions: Home of Fruits and food consumption records, and Sexual identity: NR environment, availability/ Vegetables – Parent examination of foods served at Disability: NR access Survey several schools Geographic: Urban Sociocultural: NR (Hearn et al., Number of items and sample size Socioeconomic: Covariates – 1998) – NR SES, race; Related variables – Reliability – Internal consistency; employment/unemployment, Validity – NR education Life course exposure: NR School Lunch Individual level Race/ethnicity: AA, white Living and working Availability and Survey of parents and children, Sex: NR conditions: Availability and Accessibility of food consumption records, and Sexual identity: NR access of foods at school Fruit and Vegetable examination of foods served at Disability: NR Sociocultural: NR Survey schools Geographic: Urban Socioeconomic: Covariates – (Hearn et al., Number of items and sample size SES, race 1998) – NR Life course exposure: NR Reliability – NR; Validity – NR 392 Evaluating Obesity Prevention Efforts

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TABLE E-5 Continued Social determinants: Population at risk: living and working Level, purpose, description, race/ethnicity; sex; sexual conditions; sociocultural; sample size, psychometric identity; disability; socioeconomic; life course Tool/Method properties geographic location exposure System for Individual level Race/ethnicity: AA, Living and working Observing Play To directly observe group PA and Hispanic, white conditions: School facility and Leisure measure leisure time physical Sex: NR adequacy/appeal or quality Activities in activity of adolescents Sexual identity: NR Sociocultural: NR Youth for Middle Number of items and sample size Disability: NR Socioeconomic: Related Schoolers – NR; researcher-administered, Geographic: Urban variables – WIC free/reduced (McKenzie, 2000) direct observation school lunch program Reliability – inter-rater; Validity Life course exposure: NR – concurrent System for Individual level Race/ethnicity: AA, Living and working Observing Play To develop SOPARC and test Hispanic, white, conditions: PA at parks and Recreation its use by observing 16,244 multiethnic and playgrounds, facility in Communities individuals in 165 park areas Sex: NR adequacy/appeal or quality (SOPARC) Items – NR; researcher- Sexual identity: NR Sociocultural: NR (McKenzie et al., administered, direct observation Disability: NR Socioeconomic: Covariates – 2006) N=16,244 Geographic: Urban SES, race; Related variables Reliability – inter-rater; Validity – income – NR Life course exposure: NR Principal/Food Individual level Race/ethnicity: AA, AI/ Living and working Service Director To examine associations between AN, Hispanic, Asian, conditions: Environment, Survey of School high school student lunch patterns white policy Food Policies and vending machine purchases, Sex: NR Sociocultural: NR (Neumark-Sztainer and school food environment and Sexual identity: NR Socioeconomic: Related et al., 2005) policies Disability: NR variables – WIC free/reduced Items – NR; questionnaire Geographic: Urban school lunch program N=1,088 high school students Life course exposure: NR Reliability – NR; Validity – NR Observational Individual level Race/ethnicity: AA, white Living and working System for To develop the OSRAC-Preschool Sex: M/F conditions: NR Recording PA Version, to measure PA levels and Sexual identity: NR Sociocultural: NR in Children for related factors in 3- to 5-yr-old Disability: NR Socioeconomic: Covariates – Preschoolers children in preschools Geographic: NR SES, race; Related variables (OSRAC) Researcher-administered – education (Pate et al., 2008) N=493 children 3-5 yrs old in 24 Life course exposure: NR preschools Reliability – inter-rater; Validity – NR continued Appendix E 393

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TABLE E-5 Continued Social determinants: Population at risk: living and working Level, purpose, description, race/ethnicity; sex; sexual conditions; sociocultural; sample size, psychometric identity; disability; socioeconomic; life course Tool/Method properties geographic location exposure Objectively Community level Race/ethnicity: AA, Living and working Measured Access To examine relationship between Hispanic, white conditions: Facility access/ to Recreational number and proximity of PA Sex: Female availability/proximity Facilities facilities and perceptions; compare Sexual identity: NR Sociocultural: NR (Scott et al., 2007) objective and self-report measures Disability: NR Socioeconomic: Covariates – as predictors of PA; GIS protocol Geographic: Urban SES, race N=1,367 girls Life course exposure: NR Reliability – NR; Validity – predictive Perceived Access Individual level Race/ethnicity: AA, Living and working to Recreational To examine relationship between Hispanic, white conditions: PA environment, Facilities number and proximity of PA Sex: Female recreational facilities (Scott et al., 2007) facilities and perceptions; compare Sexual identity: NR Sociocultural: NR objective and self-report measures Disability: NR Socioeconomic: Covariates – as predictors of PA; GIS protocol Geographic: NR SES, race Self-administered questionnaire Life course exposure: NR N=1367 girls Reliability – NR; Validity – predictive Girls’ Health Individual level Race/ethnicity: AA Living and working Enrichment Development of an after-school Sex: Female conditions: Availability, Multi-Site Studies obesity-prevention program Sexual identity: NR access, home environment (GEMS) Measures for AA girls; part of the GEMS Disability: NR Sociocultural: Individual (Story et al., 2003a) project to test interventions Geographic: NR variables related to diet, PA, designed to reduce excess weight and body image; Covariates gain – knowledge, psychological Self-administered factors (e.g., self-efficacy, N=54 girls 6-11 yrs old beliefs, preferences) Reliability – internal consistency; Socioeconomic: Related Validity – NR variables – low income, education, female headed households, home ownership/ values Life course exposure: NR GEMS Measure: 25 items Low Fat Food Practices (Story et al., 2003a) 394 Evaluating Obesity Prevention Efforts

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TABLE E-5 Continued Social determinants: Population at risk: living and working Level, purpose, description, race/ethnicity; sex; sexual conditions; sociocultural; sample size, psychometric identity; disability; socioeconomic; life course Tool/Method properties geographic location exposure GEMS Measure: Items – NR Obesity Prevention Questionnaire (Story et al., 2003a) GEMS Measure: Items – NR Weight Control Reliability – internal consistency Behaviors (Story et al., 2003a) GEMS Measure: 31 items Perceived Food Reliability – internal consistency Availability Questionnaire (Story et al., 2003a) GEMS Measure: 29 items Availability of Reliability – internal consistency Lower-Fat and Higher-Fat Foods (Story et al., 2003a) GEMS Measure: 10 items Self-Efficacy for Reliability – internal consistency Healthy Food Preparation (Story et al., 2003a) GEMS Measure: 28 items GEMS Activity Questionnaire (Story et al., 2003a) GEMS Measure: 5 items Motivation for Reliability – internal consistency Healthy Eating (Story et al., 2003a) continued Appendix E 395

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TABLE E-5 Continued Social determinants: Population at risk: living and working Level, purpose, description, race/ethnicity; sex; sexual conditions; sociocultural; sample size, psychometric identity; disability; socioeconomic; life course Tool/Method properties geographic location exposure GEMS Measure: 2 items Motivation for Reliability – internal consistency Physical Activity (Story et al., 2003a) GEMS Measure: 17 items Physical Activity Reliability – internal consistency Outcome Expectancies (Story et al., 2003a) GEMS Measure: 17 items Physical Activity Reliability – internal consistency Preference (Story et al., 2003a) GEMS 5 items Measure: Parent Reliability – internal consistency Encouragement for Healthy Eating (Story et al., 2003a) GEMS Measure: 4 items Physical Activity Reliability – internal consistency Self-Concept for 8-10 year olds (Story et al., 2003a) GEMS Measure: 6 items Diet Knowledge for 8-10 year olds (Story et al., 2003a) GEMS Measure: 4 items TV Viewing Reliability – internal consistency Questionnaire for 8-10 year olds (Story et al., 2003a) 396 Evaluating Obesity Prevention Efforts

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TABLE E-5 Continued Social determinants: Population at risk: living and working Level, purpose, description, race/ethnicity; sex; sexual conditions; sociocultural; sample size, psychometric identity; disability; socioeconomic; life course Tool/Method properties geographic location exposure GEMS 5 items Measure: Home Environmental Factors Related to Physical Activity (Story et al., 2003a) GEMS Measure: 6 items Parental Support Reliability – internal consistency of Daughters’ Activity Levels (Story et al., 2003a) GEMS Measure: 9 items and 5 items, respectively Self-Efficacy for Reliability – internal consistency Physical Activity and Self-Efficacy for Physical Activity with Daughter (Story et al., 2003a) GEMS Measure: 9 items Self-Efficacy for Reliability – internal consistency Healthy Eating (Story et al., 2003a) GEMS Measure: 2 items Fruit and Vegetable Reliability – internal consistency Snack Accessibility in the Home (Story et al., 2003a) GEMS Measure: 12 items Healthy Choice Reliability – internal consistency Behavioral Interventions (Story et al., 2003a) continued Appendix E 397

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TABLE E-5 Continued Social determinants: Population at risk: living and working Level, purpose, description, race/ethnicity; sex; sexual conditions; sociocultural; sample size, psychometric identity; disability; socioeconomic; life course Tool/Method properties geographic location exposure School Lunch Organizational level Race/ethnicity: AI/AN Living and working Menu and Recipe To collect 5 consecutive days Sex: M/F conditions: Food accessibility, Survey of school lunch menu items Sexual identity: NR availability, quality, policy/ (Story et al., 2003a) collected from 20 control and Disability: NR practice 21 intervention schools at 4 time Geographic: NR Sociocultural: NR periods; nutrient content analyzed Socioeconomic: Related Items – NR; third-party, variables – WIC free/reduced researcher-administered log school lunch program N=1,700 AI children Life course exposure: NR Reliability – NR; Validity – NR School Health Community level Race/ethnicity: AA, AI/ Living and working Policies and To assess whether states required AN, Hispanic, Asian, conditions: Policy/practice Programs Study or recommended that schools HI/PI, white Sociocultural: NR Survey prohibit junk food in vending Sex: Female Socioeconomic: Related (Taber et al., 2011) machines, snack bars, concession Sexual identity: NR variables – income stands, and parties from the 2000 Disability: NR Length of exposure: NR and 2006 School Health Policies Geographic: NR and Programs Study; state policies collected through computer- assisted telephone interviews or self-administered mailed questionnaires to school personnel and compared with Youth Risk Behavior Survey) GIS methods N=33 states Reliability – NR; Validity – NR 398 Evaluating Obesity Prevention Efforts

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TABLE E-5 Continued Social determinants: Population at risk: living and working Level, purpose, description, race/ethnicity; sex; sexual conditions; sociocultural; sample size, psychometric identity; disability; socioeconomic; life course Tool/Method properties geographic location exposure Healthy Food Community level Race/ethnicity: AA, Living and working Items Checklist To survey the range of food Hispanic, Asian, white conditions: Availability and for Elementary outlets around schools and Sex: M/F access to food quality grocery School Food examine how the availability of Sexual identity: NR stores/schools Environments healthy food in the food stores Disability: NR Sociocultural: NR (Tester et al., encountered varies by income Geographic: NR Socioeconomic: Covariates – 2011) status of the school and by SES, race; Related variables – store participation in WIC food low-income population only, assistance program; existing data; WIC, free/reduced school GIS protocol/detailed description; lunch program GIS methods Length of exposure: NR 28 items; environmental observation N=NR, 52 elementary schools and food outlets within network buffer zones Reliability – NR; Validity – NR NOTES: AA = African American, AI = American Indian; AN = Alaska Native; F = female; GIS = geographic information systems; HI/PI = Hawaiian/Pacific Islander; M = male; NR = not relevant; PA = physical activity; SES = socioeconomic status; WIC = Special Supplemental Nutrition Program for Women, Infants, and Children. Appendix E 399

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