There are currently no direct observation environmental audit tools that measure diverse
aspects of the obesity-related environment efficiently and reliably in a variety of
geographic settings. The goal was to develop a new instrument to reliably characterize
the overall properties and features of rural, suburban, and urban settings along multiple
dimensions. The Community Audit of Social, Civil, and Activity Domains in Diverse
Environments (CASCADDE) is an iPad-based instrument that incorporates GPS coordinates
and photography and comprises 214 items yielding seven summary indices. A comprehensive
spatial sampling strategy, training manual, and supporting data analysis code were
also developed. Random geospatial sampling using GIS was used to capture features
of the community as a whole. A single auditor collected 510 observation points in
30 communities (2013–2015). This analysis was done in 2015–2016. Correlation coefficients
were used to compare items and indices to each other and to standard measures. Multilevel
unconditional means models were used to calculate intraclass correlation coefficients
to determine if there was significant variation between communities. Results suggest
that CASCADDE measures aspects of communities not previously captured by secondary
data sources. Additionally, seven summary indices capture meaningful differences between
communities based on 15 observations per community. Community audit tools such as
CASCADDE complement secondary data sources and have the potential to offer new insights
about the mechanisms through which communities affect obesity and other health outcomes.
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Published online: February 10, 2017
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© 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
