the community health environmental scan survey ( chess ) is an empirical tool developed by the cih evaluation team to systematically document , map ( via gps ) , and assess the environments in which people , shop , live , work , and play as they relate to diet , physical activity , and tobacco use . the main objective of chess is to improve our understanding of the environment 's that we live in that promote healthy eating , physical activity , and tobacco use and the link between this and a population 's health behaviors and resulting health outcomes . we first performed a literature search of available tools that assess community environments related to diet , physical activity , and tobacco use . prior to chess , there were no tools addressing all three risk factors simultaneously ; however , separate tools were found that assess stores ( 20 ) , restaurants ( 21 ) , farmer 's markets , schools , workplaces , and the built environment supporting physical activity ( 2224 ) . we also consulted with international experts in the fields of diet , physical activity , and tobacco use in order to develop a framework for assessing each risk factor . some aspects of accessibility are measured using gis mapping as well as other key attributes ( e.g. hours of operation ) . affordability could not be systematically measured , although some aspects of cost data are collected . chess includes eight brief assessment tools that inventory streets , stores , restaurants , street vendors , recreational facilities , parks / gardens , vending machines , and the information environment . table 1 includes the main items of chess that are used in the analysis for this paper ( the complete listing of chess components can be found in appendix 1 ) . the assessment of a community assessment using chess is conducted via a  neighborhood walk , which initiates from selected schools within each community and extends in a 400 m radius . we used schools as the main focal point of interest because it is a common urban planning practice to define neighborhood units beginning with schools and other civic facilities ( 25 , 26 ) . furthermore , schools tend to be more than just places of education for a narrow segment of the population ; they are typically integral centers of communities ( 25 , 27 ) , and places of community growth and vitality . using schools also allows for the collection of comparable data across the cih pilot sites and provides a representative glimpse of the community . small non - chain grocery chain convenience store non - chain convenience kiosk / fixed stall / mobile stall fresh fruits and/or vegetables high - fat / salt / sugar options ( such as sweets , chips , and sugar - sweetened drinks ) low - fat / salt / sugar options variety of high - fat / salt / sugar , low- fat / salt / sugar items , fresh fruits , and/or fresh vegetables fast food chain ( global ) fast food chain ( country ) fast food chain ( local ) mixed ( fast food and fresh ) restaurant chain ( global ) restaurant chain ( country ) restaurant chain ( local ) 
 fig . 2 depicts the overall strategy for the neighborhood walk , beginning with schools in each neighborhood . the neighborhood environmental scan includes walking a 400 m radius around each school and identifying and/or surveying all stores , vending machines , restaurants , recreational facilities , vendors , and so on . the design of the cih project within each community includes administering surveys to children ( approximately 2,000 children between 12 and 14 years of age per intervention community).1 maps of the areas to be scanned were created using google earth pro , and the 400 m radii were created using a circular ruler program . chess data were collected using a personal digital device ( pda ) with integrated gps and camera ( magellan mobile mapper 6 ) . chess was conducted around a minimum of 50% and a maximum of 100% of all sampled schools ( with a minimum of 10 schools and a maximum of 20 schools in the intervention and control areas ) . to ensure reliability between raters , standard definitions were developed for categorization of the key features of each of the eight scan components and a training manual was created . members of the evaluation team went to each site and worked with the local research teams to collect data over a 1421 day period . for the first 3 days of each visit , the local researchers from each cih site were trained on the scan and participated in country level adaptations with the evaluation team . prior to the formal scanning of each community , all raters were trained using the training guidebook , practiced in the field in teams , and then one radius was completed by all raters to ensure reliability . a preliminary inter - rater reliability study of the environmental scan was conducted in one community setting using four raters . in general , the agreement was consistently high overall for the main variables including number of stores , restaurants , and parks ( kappas and ac1 close to 1.0 ) , as well as for the presence of fruits and/or vegetables ( kappa=0.707 , p<.049 and ac1=.901 , p<.00 ) ( 2 ) and tobacco ( kappa=1.000 , p<.008 and ac1=1.000 ) . in order to demonstrate the scope and impact of the chess tool , we present the results along with baseline school level data from the cih mexico site . this data illustrates two important functions of chess : ( 1 ) to define the availability and accessibility of healthy food options , and ( 2 ) to guide the development and planning of interventions . similar strategies and analyses can also be conducted to examine physical inactivity and tobacco use , but they are beyond the scope of this illustration . figure 3 presents a map of the area assessed by chess in both the intervention and control areas . each of the school radii are mapped , numbered , and noted as intervention or control area . using the schools as our focal point gives us an understanding of the types of environments in which students interface in their daily lives as well as a representative sample of the entire community as schools are distributed throughout the area , and it allows us to capture the different types of settings  rural , semi - urban , and urban  in both the intervention and control areas . overview of the control and intervention area and distribution of the selected schools in both areas . in addition to the school - centric , community - level data collected with chess , the individual - level survey data from students attending each of these schools allows for comparisons to be drawn between the community - level data and student - level behavioral data . these comparisons provide a comprehensive picture of the built environment including facilitators and barriers . in our mexico cih site example , 15 neighborhoods were scanned in the intervention and control areas . examining only the information collected relating to the food environment and the availability of cigarettes , a total of 583 stores / kiosk / fix care / mobile carts , and 168 restaurants were scanned and gis mapped . the school surveys conducted on students living in the scanned radii included a total of 4,608 youth aged 1214 years . for the modeling of environmental data and student behavior , student data was merged with environmental data that had 2,733 observations from 16 schools . for a summary of indicators used in this analysis and their descriptive statistics , refer to table 2 . more than half of the students reported eating at a fast food restaurant in the last week . the proportion of students smoking cigarettes was 14% and overall tobacco use was 17% ; it was not surprising that the overwhelming majority of tobacco use was cigarette use . summary of fast food and tobacco consumption indicators in table 3 , the results of log - linear regression models are presented that explore the association between the types of restaurants scanned and the frequency of students eating at fast food2 restaurants in the past 7 days . similar associations were explored between the availability of tobacco products in stores and student 's tobacco use behavior . food environment and food behavior the number of days of eating at fast food restaurants during the past 7 days was significantly associated with the percentage of restaurants providing fast foods , as was the percentage of restaurants providing both fast foods and healthier items ( mixed restaurant ) ( table 3 ) . there was not a significant association between the number of days of fast food and the total number of restaurants . when the students were dichotomized into those who had and those who had not eaten in fast food restaurants in the last week , a different pattern of association was observed . there was a significant association between not eating fast food and the total number of restaurants and the proportion of restaurants serving fast foods . these negative associations mean that persons will be more likely to fast food where there are more restaurants and where a higher proportion of them sell fast food . the relationship between the availability of tobacco products and student tobacco use behaviors is presented in table 4 . the odds of a student being a current cigarette smoker , smoking tobacco user , overall tobacco user , or ever having tried smoking cigarettes was greater in radii with a higher percentage of stores selling tobacco . however , a greater proportion of stores having  no sales to minor signs was significantly negatively associated with current smokeless tobacco use but not any other type of tobacco use . tobacco use and tobacco environment by comparing and contrasting the results from the environmental scan ( chess ) with student food consumption patterns and tobacco use behaviors from their surveys , we have a better understanding of the environments in which they are living . we observe that the types of restaurants and the availability of tobacco products does influence their consumption behavior . moreover , we can accurately identify the specific communities to design targeted interventions to address tobacco use and unhealthy diet . results from the chess tool highlight the importance of capturing data about the community environment . as additional layers of data are added , a more complete picture of the community can be developed in order to improve the understanding of the environmental determinates for unhealthy diet , physical inactivity , and tobacco use . the results of the information presented here can serve as a guideline for intervention development around healthy eating and tobacco use among youth . specific examples include but are not limited to : ( 1 ) improving availability of fruits / vegetables by working with local food vendors including school canteens , creating farmers markets , encouraging fast food restaurants to provide fruits and vegetables ; ( 2 ) providing educational interventions for youth about healthy food choices in restaurants and/or unhealthy aspects of tobacco use ; and ( 3 ) instituting fines / penalties for selling tobacco to minors . this is one example of many to illustrate the contribution of chess to understanding how a community 's attributes affect health behaviors in order to design effective intervention programs . other examples include but are not limited to : ( 1 ) locations of parks and recreational centers and reported physical activity , ( 2 ) types of retailers selling single cigarettes and tobacco use and ( 3 ) availability of low fat / salt / sugar food options and eating habits . there are few empirical tools available that systematically and simultaneously assess opportunities for healthy eating , physical activity , or reduced tobacco use in neighborhood environments . tools that do exist focus on physical activity levels ( 22 , 24 , 28 ) or specific aspects of food habits ( 20 , 21 ) and have been developed for use in developed countries . chess is the first tool to address all three risk factors for chronic disease simultaneously . the multifactorial nature of chronic disease and its risk factors warrants the development of tools to address proximal factors that influence unhealthy diet , physical inactivity , and tobacco use . many of the components of these tools are context specific and do not easily translate to non - western and developing country settings . the chess tool and overall methodology was created to address the gap in our current knowledge regarding community context . it is possible to identify secondary data sources and map some information about communities such as parks , stores , and restaurants . however , it is not possible to obtain reliable data on what stores sell , what restaurants sell , what vendors are selling surrounding schools , and/or type of recreational facilities available without actually physically walking and assessing the community . moreover , the availability of community gis data is limited to developing countries and they do not take into consideration the sometimes rapid changes in communities ( e.g. closing of stores , restaurants ) . one of the advantages of applying chess in the community is that it enriches one 's understanding and engagement of the community environment , which is an important factor in developing successful interventions . all western countries have recognized that the strain on health systems attributed to chronic diseases can not be sustained if the rates of chronic disease remain unabated . one of the most cost - effective investments is to implement effective prevention programs ( 29 ) . the environments in which people live , play , and work are important agents in determining their diet , physical activity , and tobacco use . in order to develop effective interventions for the future and scaling up of successful programs , an improved understanding of the complex interplay between environmental determinates and individual behavior is needed . a potential limitation of the environmental scan is that it provides a community snapshot and may not capture the dynamic nature of communities . the street markets and mobile vendors are important sources for where people buy their foods in some communities and may not be captured at the time or on the day the scan is conducted . another limitation is the ability to measure affordability , given the variability of units in how fruits and vegetables were sold , it was difficult to collect cost data that can be compared across different types of food vendors . however , the pricing data collected is informative in understanding cost of fruits and vegetable for communities where the chess was applied . the process of conducting the neighborhood walk is labor intensive ; however , once completed it serves as an important resource to the community as long as data sharing strategies are presented and discussed . although chess has face validity , it is clear that it will need to be tested in a variety of settings and further reliability and validity studies are needed . chess is the first environmental assessment tool of its kind to simultaneously assess the three key primary risk factors for chronic disease . the results of the cih research project using the chess will provide the first set of evidence of its kind on the complex interplay between behavior and environmental determinants on food consumption patterns , tobacco use , and physical activity levels . chronic disease is emerging as the greatest public health challenge of the twenty - first century . although much of the burden could be prevented through known interventions  eating a healthy diet and increasing physical activity ( 30 )  little is known about how to address the causes within a complex web of behavioral and societal factors . despite some successes in intervention programs , there remains limited evidence available on how to translate best and promising practices for chronic disease prevention into different settings . research in north america and europe has demonstrated the correlation between environmental determinants and physical activity levels and food consumption patterns ( 13 ) . the evidence generated by this research is now being translated into the development of policies around urban planning , education , health care , and social services . however , research on environmental determinants of physical activity levels and food consumption patterns in developing countries is absent . finite resources for tackling today 's pressing global health challenges mean that it is important for policy- and decision - makers to be armed with the most up - to - date data in order to efficiently and effectively allocate resources . as developing countries continue rapid modernization , a greater understanding of how the health and well - being of their citizens are affected by these changes is required .
backgroundnovel efforts and accompanying tools are needed to tackle the global burden of chronic disease . 
 this paper presents an approach to describe the environments in which people live , work , and play . 
 community health environment scan survey ( chess ) is an empirical assessment tool that measures the availability and accessibility , of healthy lifestyle options lifestyle options . 
 chess reveals existing community assets as well as opportunities for change , shaping community intervention planning efforts by focusing on community - relevant opportunities to address the three key risk factors for chronic disease ( i.e. unhealthy diet , physical inactivity , and tobacco use).methodsthe chess tool was developed following a review of existing auditing tools and in consultation with experts . 
 it is based on the social - ecological model and is adaptable to diverse settings in developed and developing countries throughout the world.resultsfor illustrative purposes , baseline results from the community interventions for health ( cih ) mexico site are used , where the chess tool assessed 583 food stores and 168 restaurants . 
 comparisons between individual - level survey data from schools and community - level chess data are made to demonstrate the utility of the tool in strategically guiding intervention activities.conclusionthe environments where people live , work , and play are key factors in determining their diet , levels of physical activity , and tobacco use . 
 chess is the first tool of its kind that systematically and simultaneously examines how built environments encourage / discourage healthy eating , physical activity , and tobacco use . 
 chess can help to design community interventions to prevent chronic disease and guide healthy urban planning .