An array of environmental and policy determinants, particularly those related to the physical environment, are associated with physical activity and should be taken into account in the design of interventions.

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The childhood obesity epidemic has stimulated the emergence of many policy and environmental strategies to increase healthy eating and active living, with relatively few research recommendations identifying the most effective and generalizable strategies. Yet, local, state, and national decision makers have an urgent need to take action, particularly with respect to lower-income and racial and ethnic populations at greatest risk. With the surge of promising and emerging policy and environmental strategies, this review provides a framework, criteria, and process modeled from existing expert classification systems to assess the strength of evidence for these strategies. Likewise, this review highlights evidence gaps and ways to increase the types and amount of evidence available to inform policy and environmental strategies. These priorities include documenting independent and interdependent effects, determining applicability to different populations and settings, assessing implementation fidelity and feasibility, identifying cumulative benefits and costs, ascertaining impacts on health equity, and tracking sustainability. 199

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Purpose:To understand the relationships between street-scale environments and rates of physical activity, it is crucial to develop reliable methods of measurement. Community audits are commonly used to test the walkability and bikability of environments, yet few have been tested for reliability.Methods:Audit tools were collected from the peer-reviewed literature, the Internet, and experts from a variety of backgrounds. Two versions of an audit instrument were created: an “analytic” (with Likert-scale and ordinal-response choices) and a “checklist” (with dichotomous response choices) audit tool. Audits were conducted in St Louis, MO for 147 street segments, representing both higher and lower income neighborhoods. The same segments were re-audited to assess interrater reliability.Results:Characteristics of the physical environment varied considerably across lower and higher income segments. For example, in the checklist audit, physical disorder was present for 67 segments in lower income segments, compared with 0 segments in higher income segments. Among 8 questions from each audit tool designed to broadly capture environmental attributes, most had moderate to poor agreement. Most of the transportation and land-use items demonstrated high (substantial or perfect) agreement, and the aesthetics and social environment items showed reliability in the moderate to fair range.Conclusions:A community audit tool can be relatively easy and quick to administer and, for many domains, is reliable. Our audit tools appear particularly well suited for capturing elements in the transportation and land-use environments.