Determinants of moderate to vigorous physical activity and obesity in children: a structural equation modeling analysis.

Background: The determinants of physical activity (PA) and body fatness in Chinese adolescents are rarely examined. This study aimed to investigate the effect of attitude toward PA, screen time, parents' socioeconomic status (SES), and exercise habit on PA and body fatness among Chinese children by using structural equation modeling (SEM) analysis.

Methods: Data obtained from the second Community Fitness Survey in Hong Kong were utilized, in which students from one secondary school of each of the 18 districts of Hong Kong were recruited. A total of 2517 questionnaires with physical fitness items were successfully distributed to students aged 13-19 years in these districts. Families' SES, parents' exercise habit, children's intention to participate in PA, amount of moderate to vigorous PA (MVPA), screen time, children's attitude toward PA, and children's body fat percentage were measured and analyzed with SEM. The structural equation model was composed of a measurement model and a structural model. The model was tested with Mplus 6. The Chi-square test, root mean square error of approximation, comparative fit index, and Tucker-Lewis index were calculated to evaluate model fit. The model was then modified based on the model fit indices.

Results: Children's intention to participate in PA was a strong predictor of their engagement in MVPA. Parents' exercise habit had both direct and indirect (via attitude) effects on their children's intention to participate in PA. Screen time was not a predictor of body composition. Children's intention to participate in PA directly affected their body composition. Children's attitude toward PA, parents' exercise habit, and SES had significant effects on the children's intention to participate in PA. Furthermore, obesity had a negative effect on the children's attitude toward PA.

Conclusion: To promote MVPA and prevent obesity in Chinese children of Hong Kong, it is important to design intervention that enhances children's intention and attitude in PA, as well as parent's exercise habits. Tailormade programs that take SES into consideration are also essential. Further studies are necessary to extend the results and test the model in other metropolitan areas in China.