Structural equation modeling of the associations between the home environment and obesity-related cardiovascular fitness and insulin resistance among Hispanic children.

Hispanic children are disproportionally affected by obesity-related risk of metabolic disease. We used the structural equation modeling to examine the associations between specific diet and physical activity (PA) behaviors at home and Hispanic children's metabolic health. A total of 187 Hispanic children and their parents from an urban community in Wisconsin participated in the study. Exposure variables included, children's daily intake of sugar-sweetened beverages (SSB) and PA; home availability of SSB and PA areas/equipment; and parents' intake of SSB and PA, assessed through self-administered questionnaires. Outcome variables for children's metabolic health included, measured anthropometrics; cardiovascular fitness assessed using the Progressive Aerobic Cardiovascular Endurance Run (PACER); and insulin resistance determined with the homeostasis model assessment of insulin resistance (HOMAIR). We found that children's daily intake of SSB was positively associated with BMI z-score, which in turn, was positively associated with HOMAIR (P < 0.05). Specific diet behaviors at home associated with children's intake of SSB, included home availability of SSB, which mediated the association between parents' and children's intake of SSB (P < 0.05). Children's PA was positively associated with PACER z-score, which in turn, was inversely associated with HOMAIR (P < 0.05). Specific PA behaviors at home associated with children's PA, included home availability of PA areas/equipment, which mediated the association between parents' and children's PA (P < 0.05). The structural equation model indices suggested a satisfactory model fit (Chi-square, X(2) = 53.1, comparative fix index = 0.92, root-mean-squared error associated = 0.04). The findings confirm the need for interventions at the family level that promotes healthier home environments by targeting poor diet and low levels of PA in all family members.

An economic evaluation of health-promotive built environment changes.

OBJECTIVES: This study aimed to help public investment decision makers see the greatest return on their built environment investments by developing an analysis framework for identifying the most promising improvement strategies and assessing the attainable return on investment. METHODS: The 2001 National Household Travel Survey sample (N=4974) from Dane County, Wisconsin, was used to develop a Spatial Seemingly Unrelated Regression model of daily vehicle miles traveled and miles walked or biked. The empirical model was used to analyze the travel impacts of hypothetical built environment changes. These travel impacts were translated into health impacts and monetary values using cost-benefit analysis. RESULTS: Two win-win built environment strategies were found: increased regional retail accessibility and increased prevalence of sidewalks. Based on the present analyses, an investment of $450 million to make sidewalks available to all Dane County residents was estimated to yield a cost-benefit ratio of 1.87 over a 10-year life cycle. CONCLUSION: Certain built environment measures could be predicted to be effective strategies for exerting a positive influence on people's travel behavior and the health of the community. Quantifiable public health benefits gained by better air quality and increased physical activity were shown to outweigh the cost of implementing the built environment measure of adding sidewalks to all roads.