Department of Physical Therapy, University of the Pacific, Stockton, California.
Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
J Adolesc Health. 2014 Sep;55(3):394-401. doi: 10.1016/j.jadohealth.2014.02.022. Epub 2014 Apr 18.
The purpose of this study was to test a conceptual model of proximal (home) and distal (neighborhood) environmental correlates of adolescent obesity.
This was a descriptive, cross-sectional study, using the 2007 National Survey of Children's Health, of 39,542 children aged 11-17 years. Structural equation modeling was used to test the fit of the model, identify direct and indirect effects of the proximal and distal environmental correlates, and determine reliabilities for latent constructs (Access to Physical Activity, Neighborhood Conditions, Social Capital Home Sedentary Behavior, and Physical Activity).
The model fitted the data well (Root Mean Square Standard Error of Approximation: .038 (90% confidence interval .038-.039), Comparative Fit Index: .950, and Tucker-Lewis Index: .934). Access to Physical Activity, Social Capital, Home Sedentary Behavior, and Physical Activity had direct effects on obesity (-.026, p = .001; .061, p < .001; .110, p < .001; and -.119, p < .001, respectively). Neighborhood Condition had indirect effects on obesity through Access to Physical Activity, Social Capital, and Home Sedentary Behavior (-.001, p = .009; .032, p < .001; and .044, p < .001, respectively). Access to Physical Activity had indirect effects on obesity through Physical Activity, Social Capital, and Home Sedentary Behavior (-.013, p < .001; -.005, p < .001; and -.005, p = .003, respectively). Home Sedentary Behavior had indirect effect on obesity through Physical Activity (.052, p <.001).
Results of this model fit to the U. S. population-based data suggest that interventions should target not only sedentary behavior and physical activity but also parent perceptions of safety, access to physical activity, and the neighborhood condition.
本研究旨在检验青少年肥胖近端（家庭）和远端（邻里）环境相关因素的概念模型。
这是一项描述性、横断面研究，使用 2007 年全国儿童健康调查的数据，调查了 39542 名 11-17 岁的儿童。结构方程模型用于检验模型的拟合度，确定近端和远端环境相关因素的直接和间接影响，并确定潜在结构（获得体育活动、邻里条件、家庭社会资本久坐行为和体育活动）的可靠性。
该模型很好地拟合了数据（均方根标准误差逼近值：.038（90%置信区间.038-.039），比较拟合指数：.950，塔克-刘易斯指数：.934）。获得体育活动、社会资本、家庭久坐行为和体育活动对肥胖有直接影响（分别为 -.026，p =.001；.061，p <.001；.110，p <.001；和 -.119，p <.001）。邻里条件通过获得体育活动、社会资本和家庭久坐行为对肥胖有间接影响（分别为 -.001，p =.009；.032，p <.001；和.044，p <.001）。获得体育活动通过体育活动、社会资本和家庭久坐行为对肥胖有间接影响（分别为 -.013，p <.001； -.005，p <.001；和 -.005，p =.003）。家庭久坐行为通过体育活动对肥胖有间接影响（.052，p <.001）。
该模型在美国人群数据中的拟合结果表明，干预措施不仅应针对久坐行为和体育活动，还应针对家长对安全、获得体育活动的看法以及邻里条件的看法。
