Community-built environment and self-rated health in Western China: a latent serial mediation within SEM of sleep quality and family functioning

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: = 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.