The Wisconsin Assessment of the Social and Built Environment (WASABE): a multi-dimensional objective audit instrument for examining neighborhood effects on health.
BACKGROUND
Growing evidence suggests that mixed methods approaches to measuring neighborhood effects on health are needed. The Wisconsin Assessment of the Social and Built Environment (WASABE) is an objective audit tool designed as an addition to a statewide household-based health examination survey, the Survey of the Health of Wisconsin (SHOW), to objectively measure participant's neighborhoods.


METHODS
This paper describes the development and implementation of the WASABE and examines the instrument's ability to capture a range of social and built environment features in urban and rural communities. A systematic literature review and formative research were used to create the tool. Inter-rater reliability parameters across items were calculated. Prevalence and density of features were estimated for strata formed according to several sociodemographic and urbanicity factors.


RESULTS
The tool is highly reliable with over 81% of 115 derived items having percent agreement above 95%. It captured variance in neighborhood features in for a diverse sample of SHOW participants. Sidewalk density in neighborhoods surrounding households of participants living at less than 100% of the poverty level was 67% (95% confidence interval, 55-80%) compared to 34% (25-44%) for those living at greater than 400% of the poverty level. Walking and biking trails were present in 29% (19-39%) of participant buffer in urban areas compared to only 7% (2-12%) in rural communities. Significant environmental differences were also observed for white versus non-white, high versus low income, and college graduates versus individuals with lower level of education.


CONCLUSIONS
The WASABE has strong inter-rater reliability and validity properties. It builds on previous work to provide a rigorous and standardized method for systematically gathering objective built and social environmental data in a number of geographic settings. Findings illustrate the complex milieu of built environment features found in participants neighborhoods and have relevance for future research, policy, and community engagement purposes.
Department of Population Health Sciences, University of Wisconsin-Madison School of Medicine and Public Health, 610 N, Walnut Street, Madison WI 53726, USA. kmalecki@wisc.edu.
Kristen C
KC
Malecki
Corinne D
CD
Engelman
Paul E
PE
Peppard
F Javier
FJ
Nieto
Maggie L
ML
Grabow
Milena
M
Bernardinello
Erin
E
Bailey
Andrew J
AJ
Bersch
Matthew C
MC
Walsh
Justin Y
JY
Lo
Ana
A
Martinez-Donate
D000328:Adult; D000368:Aged; D004779:Environment Design / Q000592:standards*; D005260:Female; D054624:Health Status Disparities; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012424:Rural Population; D012959:Socioeconomic Factors; D014922:Wisconsin