Family income and childhood obesity in eight European cities: the mediating roles of neighborhood characteristics and physical activity.

Utilizing data from the Large Analysis and Review of European Housing and Health Status (LARES) research program conducted by the WHO in eight European cities (Forli, Vilnius, Ferreira do Alentejo, Bonn, Geneva, Angers, Bratislava, Budapest), we examined whether the well-documented inverse correlation between family income and children's BMI might be explained, in part, by access to open green space and ensuing physical activity. We found that household income was inversely related to BMI among 1184 children, ages 6-18 years of age. Utilizing structural equation modeling with statistical controls for age and gender, we found evidence for two indirect paths between household income and BMI. One indirect relationship operates successively through open green space and physical activity. The second path operates through physical activity alone. The child's height and weight as well as level of physical activity were reported by their mother. Open green space was assessed by trained observers' ratings of the area surrounding the child's home. Limitations of the study and implications for better understanding of the ecological context of obesity are discussed.