title: Environmental Profile of a Community's Health (EPOCH): an instrument to measure environmental determinants of cardiovascular health in five countries.
abstract: BACKGROUND
  The environment in which people live is known to be important in influencing diet, physical activity, smoking, psychosocial and other risk factors for cardiovascular (CV) disease. However no instrument exists that evaluates communities for these multiple environmental factors and is suitable for use across different communities, regions and countries. This report describes the design and reliability of an instrument to measure environmental determinants of CV risk factors.
  
  
  RESULTS
  THE ENVIRONMENTAL PROFILE OF COMMUNITY HEALTH (EPOCH) INSTRUMENT COMPRISES TWO PARTS: (I) an assessment of the physical environment, and (II) an interviewer-administered questionnaire to collect residents' perceptions of their community. We examined the inter-rater reliability amongst 3 observers from each region of the direct observation component of the instrument (EPOCH I) in 93 rural and urban communities in 5 countries (Canada, Colombia, Brazil, China and India). Data collection using the EPOCH instrument was feasible in all communities. Reliability of the instrument was excellent (Intraclass Correlation Coefficient--ICC>0.75) for 24 of 38 items and fair to good (ICC 0.4-0.75) for 14 of 38 items.
  
  
  CONCLUSIONS
  This report shows data collection with the EPOCH instrument is feasible and direct observation of community measures reliable. The EPOCH instrument will enable further research on environmental determinants of health for population studies from a broad range of settings.
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences & McMaster University, Hamilton, Canada. clara@phri.ca
authors.forename: Clara K
authors.initials: CK
authors.lastname: Chow
authors.forename: Karen
authors.initials: K
authors.lastname: Lock
authors.forename: Manisha
authors.initials: M
authors.lastname: Madhavan
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Corsi
authors.forename: Anna B
authors.initials: AB
authors.lastname: Gilmore
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.forename: Sumathi
authors.initials: S
authors.lastname: Swaminathan
authors.forename: Patricio
authors.initials: P
authors.lastname: Lopez-Jaramillo
authors.forename: Alvaro
authors.initials: A
authors.lastname: Avezum
authors.forename: Scott A
authors.initials: SA
authors.lastname: Lear
authors.forename: Gilles
authors.initials: G
authors.lastname: Dagenais
authors.forename: Koon
authors.initials: K
authors.lastname: Teo
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D001938:Brazil; D002170:Canada; D002309:Cardiology / Q000379:methods; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology*; D002681:China; D003105:Colombia; D004032:Diet; D004777:Environment; D014943:Global Health; D006801:Humans; D007194:India; D008019:Life Style; D010465:Perception; D011634:Public Health / Q000379:methods*; D015203:Reproducibility of Results; D012307:Risk Factors; D012424:Rural Population; D014505:Urban Population