Using school environmental audits to inform policy action for obesity prevention

Background: Childhood obesity has become a major public health problem in the US. Among the many contributing factors is the lack of safe and attractive places for children to engage in physical activities.

Objectives: Focusing on schools as important behavioral settings for children, this study used a newly developed school audit instrument to measure the school environment to identify specific improvements to better support healthy outdoor activities, especially walking.

Methods: The audit instrument was developed based on literature reviews and field tests, and finalized after reliability assessments. Trained auditors assessed 79 school campuses and their 314 frontage/adjacent street segments across diverse communities in Texas.

Findings: The instrument included factual items capturing land uses, street/traffic/parking conditions, lighting and amenities, signs, and unattractive items; and perceptual items rating surveillance, maintenance, cleanliness, visual quality, safety and attractiveness. The inter-rater reliability was acceptable (Kappa=0.839, ICC=0.602), and the test-retest reliability was good (Kappa=0.903, ICC=0.774). School campus audits revealed several physical conditions requiring improvements: adjacency to vacant/abandoned/undeveloped areas (19 schools), sidewalk/walkway connections to school buildings (14 lacked), designated pick-up/drop-off areas (21 lacked), and trails/paths (73 lacked). Street audits also identified priority elements for improvements: street lights (25% lacked), traffic calming devices (85% lacked), benches and trash cans (96% lacked), bike lanes (98% lacked), unattractive/discarded items (75% with 1 or more items), and sidewalk obstructions (many with poles, parked cars, mail boxes, etc.).

Conclusions: Environmental audits can help identify areas needing improvement, facilitating policy development toward creating healthier communities for reducing childhood obesity.