Health-related quality of life in adolescents: individual and combined impact of health-related behaviors (DADOS study)

Associations of sleep time, quality of life, and obesity indicators on physical literacy components: a structural equation model

AIM

To verify the association between ideal sleep time and physical literacy components while also considering multiple mediators, such as quality of life and obesity, using a sample of adolescents.

METHODS

This cross-sectional study consisted of 470 adolescents aged 11-17 years from southern Brazil. Sleep time, health-related quality of life, and physical literacy components (i.e., physical education enjoyment, sports participation, sedentary behavior, moderate to vigorous physical activity, sex, and age) were evaluated through self-reported questionnaires. In addition, body mass index (BMI), and waist circumference were determined. The theoretical/statistical support of the structural equation model was evaluated according to fit parameters and strength of association.

RESULTS

A direct association was observed between more sleep time and lower levels of obesity. The obesity indicators also had a negative association with HqOL, and HqOL had a positive association with physical literacy. The indirect associations indicated that the ideal sleep time was positively associated with HqOL and physical literacy components, considering the negative mediation effect of obesity. The model explains physical literacy in 31% of the variance (R = 0.31).

CONCLUSION

There was an indirect association between ideal sleep duration and quality of life and between both variables with physical literacy. These relationships occur even considering the negative influence of obesity. Therefore, a child who sleeps adequately has a higher likelihood of being physically active, regardless of obesity, potentially enhancing overall quality of life across various domains.

Spanish validation of the simple lifestyle indicator questionnaire: validity and reliability analysis

Introduction

It has been shown that lifestyle is a highly modifiable determinant having a direct effect on the health status. Therefore, short and simple questionnaires assessing the lifestyle of the general and clinical population are needed to create interventions on behavioral aspects that can improve the health status. The Simple Lifestyle Indicator Questionnaire (SLIQ) is a validated health scale in English that combines five lifestyle factors: diet, exercise, alcohol consumption, tobacco use, and stress level. The objective of this study was to validate the SLIQ questionnaire in Spanish by analyzing the scale's validity and reliability. Its discriminatory power of the scale was also examined by evaluating the differences in health outcomes according to the levels of adherence to a healthy lifestyle.

Methods

The sample consisted of 745 participants with an average age of 39.94 (SD: 16.99). A transcultural adaptation process was carried out to validate the SLIQ questionnaire in the Spanish context, to determinate the structural equivalence of the Spanish version as compared to the English version, and to assess the psychometric properties of the scale. PREDIMED and IPAQ scales were used to analyze the convergent validity of the Spanish version of the SLIQ regarding to diet and exercise, and the questionnaires SF-12 and DASS-21 questionnaires were used to assess the capacity of the Spanish version of the SLIQ to discriminate health status related to different levels of reported lifestyles.

Results

Regarding validity, the results indicate significant correlations between the different dimensions of the SLIQ questionnaire and those used as a reference. As for reliability, the test-retest analyses reveal a high temporal consistency for the scores obtained on the questionnaire. Finally, the differences found in anxiety, depression, and quality of life, with regard to the different levels of adherence in the SLIQ questionnaire, suggest that the questionnaire's Spanish version has adequate discriminatory power.

Discussion

The obtained correlation coefficients between the SLIQ and the other standardized measures pointed out the adequate convergent validity of the instrument. Moreover, the test-retest results demonstrated the stability of the results obtained through this questionnaire. Finally, the lifestyle categories derived from the SLIQ showed a high ability to discriminate between participants' health profiles. Hence, it can be concluded that the Spanish version of the SLIQ questionnaire is a valid and reliable tool for the quick and effective assessment of lifestyle.

Association between healthy lifestyle factors and health-related quality of life among Chinese adolescents: the moderating role of gender

BACKGROUND

To examine the associations of the independent and combined healthy lifestyle factors with health-related quality of life (HRQOL) in adolescents, and to test the moderating role of gender.

METHODS

This cross-sectional study included 5125 adolescents aged between 11 and 20 years. They provided self-reported data on six healthy lifestyle factors, including never smoking, never drinking, good sleep quality, sufficient sleep duration, appropriate Internet use, and adequate physical activity. Adolescents' HRQOL was evaluated using the Pediatric Quality of Life Inventory version 4.0. Linear regression models were conducted to explore the association of individual and combined healthy lifestyle factors with adolescents' HRQOL. We further performed stratified analyses and likelihood ratio test to explore the moderating role of gender in these associations.

RESULTS

Of the included adolescents, the proportions with 0-2, 3, 4, and 5-6 healthy lifestyle factors were 13.6%, 26.4%, 44.3%, and 15.7%, respectively. Compared to adolescents with composite healthy lifestyle scores of 0-2, those with scores of 3, 4, or 5-6 had significantly higher HRQOL scores across all dimensions, summary scales, and total scale in both unadjusted and adjusted models. Specifically, adolescents with 5-6 healthy lifestyle factors had a total scale score that was 19.03 (95%CI: 17.76 to 20.30) points higher than their counterparts who only had 0-2 healthy lifestyle factors. Significant dose-response patterns were also observed in aforementioned associations. Gender was a significant moderator in the associations between composite healthy lifestyle groups and HRQOL scores, except for the social functioning dimension.

CONCLUSIONS

Our results confirmed that combined healthy lifestyle factors were associated with improved HRQOL among adolescents, with a stronger association observed in girls. These findings underscore the necessity for education and healthcare authorities to design health-promoting strategies that encourage multiple healthy lifestyle factors in adolescents, with the objective of enhancing their overall health outcomes.

The individual and combined associations of health behaviours with health-related quality of life amongst junior high school students in China

Objectives

This study aimed to investigate the individual and joint associations of sedentary behaviour, physical activity (PA), sleep and breakfast eating on health-related quality of life (HRQoL) amongst Chinese junior high school students.

Methods

Data were from 783 junior high school students who participated in a health behaviour and health survey in Jining city of Shandong province of China. HRQoL was measured by the EuroQol five-dimensional questionnaire, youth version (EQ-5D-Y). Multivariable logistic and linear regressions were applied to examine the associations between health behaviours and HRQoL.

Results

Multivariable regression analyses showed that using a computer ≥ 2 h a day (vs. < 2 h/day) is associated with increased likelihood of having health problems in the three EQ-D-Y dimensions, including walking, looking after self and doing usual activities. Lower PA is associated with more problems in feeling worried, sad or unhappy, and with a lower visual analogue scale (VAS) score. Students who had insufficient sleep time (e.g., <7 h/day), and skipped eating breakfast were more likely to experience lower HRQoL in the dimensions of having pain or discomfort, and feeling worried, sad or unhappy, and a lower VAS score than those students who had longer sleep time and no breakfast skipping. Students who reported having the combined ≥ 2 unhealthy behaviours relative to the peers with 0-1 unhealthy behaviours were more likely to have lower HRQoL.

Conclusion

The findings in the present study underline the importance of promoting healthy behaviours in order to improve HRQoL amongst Chinese junior high school students.

Independent and combined effects of lifestyle behaviors on adolescent health-related quality of life

OBJECTIVE

To investigate the independent and combined effects of lifestyle behaviors, including physical activity, sedentary behavior, sleep duration and food intake, in the health-related quality of life (HRQoL) of Brazilian adolescents.

METHODS

Cross-sectional school-based study, with the participation of 306 adolescents aged 14 to 18 years. A questionnaire was applied with structured questions to collect lifestyle behaviors data. Perception of the HRQoL was identified using the Kidscreen-27. The study used covariance analysis and linear regression models for statistical analysis.

RESULTS

Adolescents who reported ≤ 2 hours/day of screen-based sedentary behavior and sleep duration equivalent to 8-10 hours/night presented significantly higher HRQoL. Adolescents who reported joint adherence ≥ 3 healthy lifestyle behaviors demonstrated approximately two [OR=2.12] to three times [OR=3.04] more chance of presenting higher perceptions of HRQoL.

CONCLUSION

Although healthy lifestyle behaviors had a positive independent effect on HRQoL, joint adherence to healthy behaviors enhances the cumulative effect.

Body size, form, composition, and a healthy lifestyle associates with health-related quality of life among Portuguese children

OBJECTIVES

This study aimed to describe the relationship between body size, form, and composition, and children's lifestyle on health-related quality of life (HRQoL).

METHODS

This cross-sectional study comprised 1333 children (9.05 ± 0.75 years; 683 females) living in mainland Portugal. Objective anthropometric measures were collected. Parents answered a standardized questionnaire related with children's lifestyle (e.g., sport participation, screen- and sleep-time) and family socioeconomic status (e.g., parental education). HRQoL was measured using the Portuguese version of the KIDSCREEN-27. Scores were categorized into low and high using a sex-specific normative cut-off from European children. A healthier score was created including positive scores for body weight, abdominal obesity, sport participation, sleep- and screen-time.

RESULTS

Body size, form and composition were correlated with children's physical wellbeing. However, sex differences were found in which parameters were associated with wellbeing. Among boys, the body mass index, waist circumference, waist-to-height ratio, subscapular and suprailiac skinfold were most correlated with wellbeing, while waist circumference and subscapular skinfold showed the strongest correlations for girls. Sleep duration and sport participation revealed a significant relationship with girls' HRQoL. A logistic regression analysis (adjusted for parental education) revealed that boys scoring 4 or 5 in the healthier index had an increased likelihood of high HRQoL level compared to those fulfilling none.

CONCLUSIONS

Future programs aimed at reducing obesity, particularly central obesity, and incorporating multiple health indicators and behaviors, such as sport participation and sleep duration may help improve children's health and wellbeing.

The mediating effect of food choice upon associations between adolescent health-related quality of life and physical activity, social media use and abstinence from alcohol

BACKGROUND

Understanding how health-related quality of life (HRQoL) is related to lifestyle factors during adolescence is crucial to effective health promotion. The aim of this analysis was to identify associations between HRQoL and lifestyle and to determine the degree to which they are mediated by food choices in adolescents.

METHODS

The Wellbeing in Schools (NI) survey (N = 1609; 13-14 years) assessed HRQoL using the Kidscreen52. Food choice was assessed by Food Frequency Questionnaire (FFQ) and physical activity was assessed using the Physical Activity Questionnaire for Adolescents (PAQ-A). Social media and alcohol abstinence were self-reported.

RESULTS

Path analysis indicated that fruit and vegetable intake was associated with higher HRQoL on dimensions of moods and emotions, parent relations and home life, financial resources, and social support and peers. Bread and diary intake was related to higher physical wellbeing. Protein was associated with higher psychological wellbeing, moods and emotions, self-perception, parent relations and home life, financial resources, and lower social support and peers. Junk food was related to lower moods and emotions. Males had higher psychological wellbeing, moods and emotions, parental relations and home life. Females had higher self-perception, autonomy, and social support and peers. Greater physical activity explained higher HRQoL on all dimensions. Less social media was associated with higher psychological wellbeing, moods and emotions, self-perception, parent relations and home life, and school environment. Alcohol abstinence was associated with higher physical wellbeing, psychological wellbeing, moods and emotions, self-perception, parent relations and home life, and school environment dimensions.

CONCLUSION

Intervention to promote HRQoL in adolescents should consider food choices whilst encouraging physical activity, discouraging social media and deterring alcohol, and targeting boys and girls separately.

Health-promoting domains and lifestyle of a sample of Brazilian adolescents

BACKGROUND

Reports indicate that the health habits of adults are strongly linked to the behaviors incorporated in adolescence. Therefore, it is essential to monitor the lifestyle of adolescents to promote their present and future health. This study aimed to identify differences in health-promoting domains according to demographic data and lifestyle behaviors, including physical activity, sedentary behavior, sleep duration, and food intake, in a sample of Brazilian adolescents.

MATERIALS AND METHODS

Cross-sectional school-based study, with the participation of 306 adolescents aged 14 to 18 years. A questionnaire was applied with structured questions to collect demographic data and lifestyle behaviors. To examine the health-promoting domains the Adolescent Health Promotion Scale (AHPS) was used. Data were analyzed using multivariate analysis.

RESULTS

Scores attributed to each of the health-promoting domains showed substantial variations according to sex, age, year of study, parents' schooling, and family economic class. After adjustment for covariables, the adolescent who presented significantly higher scores equivalent to the overall index of health promotion reported being more physically active (F = 4.848; P = 0.009), sleeping 6-8 hours/night (F = 2.328; P = 0.046), consuming fruit/vegetable more frequently (F = 3.168; P = 0.024), while sedentary behavior and intake of sweetened products/soft drinks have not shown any significant effect.

CONCLUSION

The findings confirmed the consistent positive influence of health-promoting domains assessed by AHPS on healthy lifestyle behaviors, suggesting in the intervention programs aimed at adopting healthy lifestyle approaches it is important enough to contemplate actions aimed at all the areas of health promotion with characteristics aimed at nutrition behavior, social support, health responsibility, life appreciation, exercise behavior, and stress management.

The bidirectional longitudinal association between health-related quality of life and academic performance in adolescents: DADOS study

PURPOSE

Although previous evidence has suggested a relationship between health-related quality of life (HRQoL) and academic performance, the directionality of this association is understudied and remains to be clarified. Thus, the primary objective of this study was to explore the bidirectional association between HRQoL and academic performance in adolescents between two timepoints with a 24-month interval. A secondary aim was to analyze whether this association varies between boys and girls.

METHODS

This is a bidirectional longitudinal analysis with 257 adolescents (13.9 ± 0.3 years at baseline) from the DADOS study. HRQoL was measured using the KIDSCREEN-10 questionnaire. Academic performance was assessed through academic grades and the Spanish version of the Science Research Associates Test of Educational Ability.

RESULTS

Cross-lagged analyses revealed that HRQoL at baseline was not associated with academic performance 24 months later, while all the academic grades and the overall score of academic abilities at baseline were positively associated with HRQoL at follow-up in adolescents. Results of the stratified analyses by sex were largely similar. Specifically, in girls, math, language, physical education, and grade point average at baseline were positively associated with HRQoL 24 months later, while in boys, all the academic grades indicators (except physical education), numeric ability, and the overall score of academic abilities at baseline were positively associated with HRQoL at follow-up.

CONCLUSION

These findings suggest that academic performance in early adolescence may predict HRQoL 24 months later. Health and education professionals could benefit from collaborating to achieve both improved academic performance and HRQoL in youth.

Anthropometric, Lifestyle Characteristics, Adherence to the Mediterranean Diet, and COVID-19 Have a High Impact on the Greek Adolescents’ Health-Related Quality of Life

Objective: The study aimed at analyzing the relationship between anthropometric characteristics, lifestyle, and dietary habits, as well as the burden of the pandemic on the health-related quality of life among Greek pupils. Research methods and procedures: On the whole, 2088 adolescents aged 12–18 years from Attica, Greece, were enlisted in this school-based cross-sectional study that took place in May–December 2021. Health-related quality of life was estimated through the KIDSCREEN-27 questionnaire, adherence to the Mediterranean diet—through the KIDMED test. For the empirical and econometric analyses, the Mann–Whitney U and Kruskal–Wallis means comparison tests were utilized; multiple linear regression was used accordingly. Results: The present study provides evidence to the fact that boys, younger adolescents, adolescents living with both parents and with highly educated mothers had a better health-related quality of life. Concerning their eating practices, positive predictors were consuming a better-quality breakfast, having all five meals daily, consuming lunch and dinner with parents, and higher adherence to the Mediterranean diet. Moreover, sufficient night sleep time, fewer hours spent on screen viewing, more frequent walks, and having hobbies were linked to the health-related quality of life with a positive sign. In contrast, negative predictors were higher body mass index and everyday life difficulties due to the COVID-19 pandemic crisis. Conclusions: Greek adolescents’ anthropometric characteristics, BMI, lifestyle and sedentary habits, eating habits, and adherence to the Mediterranean diet were significantly related to their perceived health-related quality of life during the pandemic.

Dietary patterns and health-related quality of life among Iranian adolescents

PURPOSE

Examining the associations of a-posteriori-defined dietary patterns and health-related quality of life (HRQOL) among Iranian adolescents.

METHODS

This cross-sectional study was conducted among 900 apparently healthy students (mean age 15.33 years; 53.0% female) during 2020-21. The validated Persian version of self-report Pediatric Quality of Life Inventory™ Version 4.0 Generic Core Scales (PedsQL) for healthy adolescents was used in an online survey to assess HRQOL. Total, physical health, psychosocial health, emotional functioning, social functioning, and school functioning PedsQL scores were calculated, and impaired HRQOL was defined as > 1 standard deviation below the total population sample mean PedsQL scores. A validated food frequency questionnaire was used to assess dietary intakes during telephone interviews. Daily intakes of 20 predefined food groups were calculated and submitted to the principal component factor analysis to identify a-posteriori-defined dietary patterns.

RESULTS

Three major dietary patterns labeled as Mediterranean, mixed, and unhealthy were identified, of which only the Mediterranean pattern characterized by high intakes of vegetables, fruits, olives, potatoes, eggs, nuts and legumes, pickles, low-fat dairy, fish, poultry, and vegetable oils was consistently associated with HRQOL. Controlling for covariates in the multivariable-adjusted binary logistic regression analysis, participants in the top tertile of Mediterranean pattern score were less likely to have impaired HRQOL than those in the bottom tertile (total: OR 0.25; physical health: OR 0.35; psychosocial health: OR 0.15; emotional functioning: OR 0.17; social functioning: OR 0.15; and school functioning: OR 0.18; all P < 0.010).

CONCLUSION

Current findings indicate that an a-posteriori-defined Mediterranean-style dietary pattern is associated with better HRQOL among healthy Iranian adolescents.