title: Observer ratings of neighborhoods: comparison of two methods.
abstract: BACKGROUND
  Although neighborhood characteristics have important relationships with health outcomes, direct observation involves imperfect measurement. The African American Health (AAH) study included two observer neighborhood rating systems (5-item Krause and 18-item AAH Neighborhood Assessment Scale [NAS]), initially fielded at two different waves. Good measurement characteristics were previously shown for both, but there was more rater variability than desired. In 2010 both measures were re-fielded together, with enhanced training and field methods implemented to decrease rater variability while maintaining psychometric properties.
  
  
  METHODS
  AAH included a poor inner city and more heterogeneous suburban areas. Four interviewers rated 483 blocks, with 120 randomly-selected blocks rated by two interviewers. We conducted confirmatory factor analysis of scales and tested the Krause (5-20 points), AAH 18-item NAS (0-28 points), and a previous 7-item and new 5-item versions of the NAS (0-17 points, 0-11 points). Retest reliability for items (kappa) and scales (Intraclass Correlation Coefficient [ICC]) were calculated overall and among pre-specified subgroups. Linear regression assessed interviewer effects on total scale scores and assessed concurrent validity on lung and lower body functions. Mismeasurement effects on self-rated health were also assessed.
  
  
  RESULTS
  Scale scores were better in the suburbs than in the inner city. ICC was poor for the Krause scale (ICC=0.19), but improved if the retests occurred within 10 days (ICC=0.49). The 7- and 5-item NAS scales had better ICCs (0.56 and 0.62, respectively), and were higher (0.71 and 0.73) within 10 days. Rater variability for the Kraus and 5- and 7-item NAS scales was 1-3 points (compared to the supervising rater). Concurrent validity was modest, with residents living in worse neighborhood conditions having worse function. Unadjusted estimates were biased towards the null compared with measurement-error corrected estimates.
  
  
  CONCLUSIONS
  Enhanced field protocols and rater training did not improve measurement quality. Specifically, retest reliability and interviewer variability remained problematic. Measurement error partially reduced, but did not eliminate concurrent validity, suggesting there are robust associations between neighborhood characteristics and health outcomes. We conclude that the 5-item AAH NAS has sufficient reliability and validity for further use. Additional research on the measurement properties of environmental rating methods is encouraged.
authors.affiliation: Institute on Development & Disability, Oregon Health & Science University, Portland, OR, USA. andresee@ohsu.edu.
authors.forename: Elena M
authors.initials: EM
authors.lastname: Andresen
authors.forename: Theodore K
authors.initials: TK
authors.lastname: Malmstrom
authors.forename: Mario
authors.initials: M
authors.lastname: Schootman
authors.forename: Fredric D
authors.initials: FD
authors.lastname: Wolinsky
authors.forename: J Philip
authors.initials: JP
authors.lastname: Miller
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Miller
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D002947:Cities / Q000706:statistics & numerical data; D005163:Factor Analysis, Statistical; D006801:Humans; D007407:Interviews as Topic; D015588:Observer Variation; D015203:Reproducibility of Results; D012111:Residence Characteristics / Q000706:statistics & numerical data; D013383:Suburban Population / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data