RESUMO
Background: Public health research has turned towards examining upstream, community-level determinants ofcardiovascular disease risk factors. Objective measures of the environment, such as those derived from direct observation,and perception-based measures by residents have both been associated with health behaviours. However, current methodsare generally limited to objective measures, often derived from administrative data, and few instruments have beenevaluated for use in rural areas or in low-income countries. We evaluate the reliability of a quantitative tool designed tocapture perceptions of community tobacco, nutrition, and social environments obtained from interviews with residents incommunities in 5 countries.Methodology/ Principal Findings: Thirteen measures of the community environment were developed from responses toquestionnaire items from 2,360 individuals residing in 84 urban and rural communities in 5 countries (China, India, Brazil,Colombia, and Canada) in the Environmental Profile of a Communitys Health (EPOCH) study. Reliability and other propertiesof the community-level measures were assessed using multilevel models. High reliability (.0.80) was demonstrated for allcommunity-level measures at the mean number of survey respondents per community (n = 28 respondents). Questionnaireitems included in each scale were found to represent a common latent factor at the community level in multilevel factoranalysis models.Conclusions/ Significance: Reliable measures which represent aspects of communities potentially related to cardiovasculardisease (CVD)/risk factors can be obtained using feasible sample sizes. The EPOCH instrument is suitable for use in differentsettings to explore upstream determinants of CVD/risk factors.