Community-built environment and self-rated health in Western China

A latent serial mediation within SEM of sleep quality and family functioning

Bibliographic Data

ID22079355
AuthorsLansicheng Yao (North Sichuan Medical University), Jacquline Tham (0000-0003-0966-2425, Management and Science University, corresponding author), Qing Pan (0000-0003-1253-0490, West China Medical Center of Sichuan University), Xiaobing Tian (0000-0003-2695-0904, North Sichuan Medical University, corresponding author)
Year2026
Volume14
Pages1787068-1787068
Publication date2026-04-24
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueFrontiers in Public Health (JOURNAL)
Journal identifiersISSN: 2296-2565 • E-ISSN: 2296-2565
PublisherFrontiers Media SA (PUBLISHER • CH)
DOI10.3389/fpubh.2026.1787068
PMID42110242
OpenAlexW7155559935
LanguageEN
References cited50

Objectives To clarify the underlying relationship between community-built environment and self-rated health in rapidly urbanizing China and examine the chained mediation effects of sleep quality and family functioning. Methods Data were derived from a community-based cross-sectional survey conducted in Gaoping District, Sichuan Province. The Chinese versions of the Neighborhood Environment Walkability Scale-Abbreviated, the 36-Item Short Form Health Survey, the Insomnia Severity Index, and the Family Assessment Device were used to assess the community-built environment, self-rated health, sleep quality, and family functioning. Based on the Structural Equation Model, a structural equation model was constructed, and the weighted least squares mean- and variance-adjusted estimator was used to test the model. After the preliminary confirmatory factor analysis, model fit was evaluated using the comparative fit index, Tucker-Lewis’s index, root mean square error of approximation, and standardized root mean square residual. Results This study included 2,705 adults (mean age 51.8 ± 18.3 years; 60% female). After adjusting for socioeconomic characteristics, the community-built environment was not significantly associated with self-rated health (all p > 0.05). In contrast, better sleep quality was identified as the strongest predictor of higher self-rated health ( β = 0.383, p < 0.001). The hypothesized serial mediation effect was not statistically significant ( β = −0.008, p = 0.068). Conclusion In the mixed urban–rural context of western China, the community-built environment was not significantly associated with the self-rated health among community-dwelling adults. Notably, sleep quality was identified as the predominant factor affecting self-rated health outcomes

Confirmatory factor analysis · Insomnia · Mediation · Sleep quality · Socioeconomic status · Structural equation modeling · Health disparities and outcomes · Sleep and related disorders · Urban Transport and Accessibility

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