title: Environmental Profile of a Community's Health (EPOCH): an ecometric assessment of measures of the community environment based on individual perception.
abstract: BACKGROUND
  Public health research has turned towards examining upstream, community-level determinants of cardiovascular disease risk factors. Objective measures of the environment, such as those derived from direct observation, and perception-based measures by residents have both been associated with health behaviours. However, current methods are generally limited to objective measures, often derived from administrative data, and few instruments have been evaluated for use in rural areas or in low-income countries. We evaluate the reliability of a quantitative tool designed to capture perceptions of community tobacco, nutrition, and social environments obtained from interviews with residents in communities in 5 countries.
  
  
  RESULTS
  Thirteen measures of the community environment were developed from responses to questionnaire items from 2,360 individuals residing in 84 urban and rural communities in 5 countries (China, India, Brazil, Colombia, and Canada) in the Environmental Profile of a Community's Health (EPOCH) study. Reliability and other properties of the community-level measures were assessed using multilevel models. High reliability (>0.80) was demonstrated for all community-level measures at the mean number of survey respondents per community (n = 28 respondents). Questionnaire items included in each scale were found to represent a common latent factor at the community level in multilevel factor analysis models.
  
  
  CONCLUSIONS
  Reliable measures which represent aspects of communities potentially related to cardiovascular disease (CVD)/risk factors can be obtained using feasible sample sizes. The EPOCH instrument is suitable for use in different settings to explore upstream determinants of CVD/risk factors.
authors.affiliation: Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada. daniel.corsi@phri.ca
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Corsi
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
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: Sumathy
authors.initials: S
authors.lastname: Rangarajan
authors.forename: Koon
authors.initials: K
authors.lastname: Teo
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
authors.forename: Clara K
authors.initials: CK
authors.lastname: Chow
mesh_terms: D001938:Brazil / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology*; D002681:China / Q000453:epidemiology; D003105:Colombia / Q000453:epidemiology; D003625:Data Collection / Q000379:methods; D006801:Humans; D007194:India / Q000453:epidemiology; D015233:Models, Statistical; D015596:Nutrition Assessment; D011634:Public Health / Q000379:methods*; D015203:Reproducibility of Results; D012107:Research Design; D012111:Residence Characteristics; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D012931:Social Environment; D011795:Surveys and Questionnaires