A review of similarities between domain-specific determinants of four health behaviors among adolescents

Returning to sport after injury: the influence of injury appraisals and post-traumatic stress symptoms on adolescent risk-taking intentions post-injury

OBJECTIVE

How youth think about injury risk can affect their decisions about whether to engage in behaviors that can lead to injury. Appraisals also influence the development of post-traumatic stress symptoms (PTSS), which occur in approximately 20% of children after a medically treated injury. The current study examined how the injury appraisals of youth are associated with the development of PTSS post-skateboarding injury, and if PTSS or perceived benefits of the sport are also associated with youths' intentions to return to the sport.

METHOD

One hundred three youth who had a medically treated skateboarding injury within the last year provided survey data on injury appraisals, PTSS, the benefits of skateboarding, and intentions to return to the sport.

RESULTS

A two-stage moderated statistical mediation path model was specified. In the first stage, there was a positive relationship between pain at injury and PTSS, which was attenuated by the moderator, perceived bad luck. PTSS fully mediated the association between perceived pain at the time of injury and intentions to return to skateboarding. In the second stage of the mediation model, the moderator perceived benefits of skateboarding, reversed the negative relationship between PTSS and intentions to return to skateboarding.

CONCLUSIONS

Skateboarders are a group at risk for injury that can lead to PTSS, and they also are likely to return to the sport despite PTSS. This research identifies factors that impact the decision to return to skateboarding after injury. Limitations of the study and implications for mental health support and injury prevention are provided.

Adolescents' Perspectives on Skateboarding and Injury Risk: The Benefits Outweigh the Risks

OBJECTIVE

Skateboarding is an increasingly popular sport among youth, despite the fact that children and adolescents are the age groups most frequently injured when skateboarding. A greater understanding of the psycho-social factors that motivate participation in skateboarding, including why youth return to the sport after serious injury from skateboarding, is needed to inform injury prevention efforts. This study addressed that gap in knowledge.

METHODS

Twenty-six Canadian adolescent skateboarders 14-17 years of age (20 males and 6 females) who had previously sustained medically attended injuries while skateboarding participated in individual interviews to explore their perspectives on skateboarding and injury risk, including reasons for returning to the sport after injury.

RESULTS

Thematic analyses revealed that participants perceived many unique benefits from skateboarding, including interpersonal benefits, mental and physical health benefits, pleasure, personal growth, and identity development. Participants uniformly identified that a major drawback was the risk of injury, with trickle-down effects of injury including a loss of social contacts (e.g., missing friends), challenges to individual identity from not participating, and injury-specific negative outcomes (e.g., pain, physical limitations). When exploring reasons participants returned to the sport and to the trick or activity that precipitated their injury, the primary theme identified was that the benefits of skateboarding significantly outweighed the costs associated with potential re-injury.

CONCLUSION

Results paint a nuanced picture of psycho-social factors that impact youths' skateboarding and decisions to return to the sport after injury. Implications for injury prevention are discussed.

Health lifestyles during adolescence: clustering of health behaviours and social determinants in Italian adolescents

BACKGROUND

Health behaviours in adolescence have a high impact on both current and future health. The literature claims a focus on social determinants and shows that these behaviours are associated. The concept of 'health lifestyles' should be considered to account for co-occurring health behaviours and determinants interactions. The aim of this study is to increase our understanding of adolescents' health lifestyles and to (i) cluster adolescents according to a comprehensive number of health behaviours and (ii) describe these groups according to sociodemographic characteristics, perceptions of life contexts (family, school, peers or neighbourhood) and perceived physical and psychosocial health conditions.

METHODS

In Italy, 906 15-year-old students participated in the cross-national Health Behaviour of School-aged Children study. Clusters were identified by applying the KAMILA clustering method and compared using analysis of variance and chi-squared tests.Results: Four clusters were identified: 'substance consumers', 'media lovers', 'active students' and 'passive students'. Each cluster exhibited different characteristics related to health behaviours and social determinants.

CONCLUSIONS

Interesting associations between health behaviours were identified, which showed the relevance of considering the adolescents' overall lifestyles. The description of each cluster permitted the identification of risks and protective factors, which may be important for designing effective health promotion activities.

Systematic review of digital interventions to support refusal self-efficacy in child and adolescent health promotion

Refusal self-efficacy protects against risky health behavior. Digital interventions have the potential to support self-efficacy due to the enactive experience provided by digital technologies. The aim of this systematic literature review was to evaluate the evidence of digital interventions to support refusal self-efficacy in child and adolescent health promotion. Following the Cochrane Collaboration guidelines, five electronic databases were searched from 2009 to 2020. The studies were assessed by two independent reviewers according to the eligibility criteria. Eligible studies were included in the review, assessed for risk of bias, synthesized narratively and assessed for evidence quality with the GRADE approach. Twenty-three studies, that examined 18 different interventions, were included in the review. The interventions included various digital elements as means to support the child and adolescent refusal self-efficacy (e.g. games, videos, feedback and activities for regulating feelings). The interventions improving refusal self-efficacy were more often used at home setting and addressed the four sources of self-efficacy with different digital elements regardless of intervention duration and intensity. Although the results on intervention effects varied and the evidence quality remained low, the overall evidence concerning these interventions was encouraging. Based on the subgroup analysis, the results were mainly encouraging among girls. When these interventions are implemented in health promotion, their benefits and weaknesses need to be considered comprehensively. The results provide information for designing and developing digital interventions to support child and adolescent refusal self-efficacy. Further research with larger sample sizes and more rigorous study designs is needed to strengthen the evidence of these interventions.

Sexual Victimization, Self-Efficacy to Refuse Sex While Drinking, and Regretting Alcohol-Involved Sex among Underserved Youth in Kampala, Uganda

The purposes of this study were to determine whether youth who have experienced sexual victimization (SV) have lower self-efficacy to refuse sex and to identify intervention strategies for rape survivors to mitigate further health-risks and harm. Cross-sectional data from the 2014 Kampala Youth Survey (n = 1134) of youth aged 12 to 18 years recruited from Uganda Youth Development Link drop-in centers were used to conduct the analyses. Multivariable statistics were computed to determine the correlates (i.e., sex, education, homelessness, problem drinking, and SV) for (1) self-efficacy to refuse sex, (2) self-efficacy to refuse sex while drinking, and (3) regretting sex due to alcohol use. Among participants, 16.9% reported SV (79% were female and 21% were male). In the final adjusted model, self-efficacy to refuse sex while drinking was only associated with homelessness (OR: 0.52; 95% CI: 0.36, 0.74). Previous SV was not associated with lower self-reports of self-efficacy to refuse sex compared to those who had not experienced SV. Additionally, SV was not associated with increased reports of regrets for sex attributed to alcohol use. Alcohol prevention strategies for the most at-risk youth, including homeless youth, are warranted to improve self-efficacy to refuse sex among youth living in the slums of Kampala.

Multiple Health Behavior Programs in School Settings: Strategies to Promote Transfer-of-Learning Through Life Skills Education

Typically, schools implement health promotion programs that focus on a single behavioral domain. Multiple related health topics may be addressed using separate interventions, potentially producing overlap in program content. However, integrative approaches in health promotion have the potential to produce interventions capable of improving multiple health behaviors. In particular, more research is needed to identify the conditions and the factors that can promote the transfer of learning to broaden the target outcomes of health promotion programs. The present study aims to identify the characteristics of an evidence-based life skills education program that can facilitate the transfer of learning to different health behaviors not initially targeted by the program, and the strategies for achieving successful transfer. A two round Delphi method was used with a diverse group of 21 experts in health promotion, life skills education, and methods of pedagogy for early adolescent students. Questionnaires with open and closed-ended questions were administered on-line. Content qualitative analysis was run, integrating codes, subcategories, and categories of the two rounds of the study. Results showed strong consensus among experts about the potential for promoting the transfer of skills from one health domain to another. Many elements were identified as important factors that facilitate the transfer of learning. Strategies for successful transfer were related to teaching methods, educational approaches, and consistency with the broader school curriculum. Findings suggest that the successful transfer of learning to a new health domain requires that educators recognize its importance and explicitly designate it as an educational aim.

Applying Mental Model Methods to Characterize Understanding of Gene-Environment Influences: The Case of Podoconiosis in Ethiopia

The rapid pace of genomic discovery has raised public expectation and concerns about the utility of new discoveries and their potential to exacerbate health disparities. Improving literacy concerning gene and environmental (GxE) contributors to disease is needed to avoid commonly observed deterministic misconceptions about genomics. Mental models approaches that incorporate community engagement processes could be used to inform GxE literacy-building interventions. We used a mental models approach to describe and systematically compare expert and lay understanding of GxE interactions, using the example of podoconiosis, a non-infectious lymphedema endemic in highland Ethiopia. Methods included: (1) specifying elicitation questions for a literature review, (2) eliciting an expert model, (3) eliciting a lay model, and (4) comparing the two models. We used a coding scheme to identify lay participants' knowledge gaps, misunderstandings and extra knowledge relative to the expert standard. Results indicated that lay participants' viewed poverty as an important susceptibility factor and considered heredity and contagion to have a joint causal influence. Experts did not endorse either of these viewpoints. Conventional expert-based interventions aimed to correct misconceptions about behaviors important for prevention may be stymied by lay views that social environmental factors have more important influences on health outcomes. GxE literacy interventions that consider multiple levels of influence including social determinants of health and personal resilience to augment health education strategies are needed in diverse settings. Novel communication approaches will be needed to help target audiences disentangle long-held conceptions of heredity and contagion.

Self-Efficacy About Sexual Risk/Protective Behaviors: Intervention Impact Trajectories Among American Indian Youth

For adolescents, normative development encompasses learning to negotiate challenges of sexual situations; of special importance are skills to prevent early pregnancy, HIV, and other sexually transmitted diseases. Disparities in sexual risk among American Indian youth point to the importance of intervening to attenuate this risk. This study explored the impact of Circle of Life (COL), an HIV prevention intervention based on social cognitive theory, on trajectories of self-efficacy (refusing sex, avoiding sexual situations) among 635 students from 13 middle schools on one American Indian reservation. COL countered a normative decline of refusal self-efficacy among girls receiving the intervention by age 13, while girls participating at age 14 or older, girls in the comparison group, and all boys showed continuing declines.

Principled Promotion of Health: Implementing Five Guiding Health Promotion Principles for Research-Based Prevention and Management of Diabetes

Background: Based on widespread critique of the moralizing paradigm that has long characterized much of the work conducted within the field of health promotion, Steno Health Promotion Research has developed a comprehensive health promotion approach consisting of five principles that constitute the framework for a new intervention paradigm. The five principles are: (1) A broad and positive health concept; (2) Participation and involvement; (3) Action and action competence; (4) A settings perspective and (5) Equity in health. Objectives: To describe a comprehensive health promotion approach consisting of five principles; to present research and development projects based on this set of principles; and to discuss experiences and results from implementing the health promotion principles in healthcare practices. Results and conclusion: The principle approach enables consolidation of hitherto disparate approaches into a single comprehensive approach. The principles have turned out to be productive and effective “management tools” that have led to new discoveries, but also helped to identify limitations.

Screening and vaccination as determined by the Social Ecological Model and the Theory of Triadic Influence: a systematic review

BACKGROUND

Vaccination and screening are forms of primary and secondary prevention methods. These methods are recommended for controlling the spread of a vast number of diseases and conditions. To determine the most effective preventive methods to be used by a society, multi-level models have shown to be more effective than models that focus solely on individual level characteristics. The Social Ecological Model (SEM) and the Theory of Triadic Influence (TTI) are such models. The purpose of this systematic review was to identify main differences and similarities of SEM and TTI regarding screening and vaccination in order to prepare potentially successful prevention programs for practice.

METHODS

A systematic review was conducted. Separate literature searches were performed during January and February 2015 using Medline, Ovid, Proquest, PubMed, University of Antwerp Discovery Service and Web of Science, for articles that apply the SEM and TTI. A Data Extraction Form with mostly closed-end questions was developed to assist with data extraction. Aggregate descriptive statistics were utilized to summarize the general characteristics of the SEM and TTI as documented in the scientific literature.

RESULTS

A total of 290 potentially relevant articles referencing the SEM were found. As for the TTI, a total of 131 potentially relevant articles were found. After strict evaluation for inclusion and exclusion criteria, 40 SEM studies and 46 TTI studies were included in the systematic review.

CONCLUSIONS

The SEM and TTI are theoretical frameworks that share many theoretical concepts and are relevant for several types of health behaviors. However, they differ in the structure of the model, and in how the variables are thought to interact with each other, the TTI being a matrix while the SEM has a ring structure. The main difference consists of the division of the TTI into levels of causation (ultimate, distal and proximal) which are not considered within the levels of the SEM. It was further found that in the articles studied in this systematic review, both models are often considered effective, while the empirical basis of these (and other) conclusions reached by their authors is in many cases unclear or incompletely specified.

Using Family-Focused Garden, Nutrition, and Physical Activity Programs To Reduce Childhood Obesity: The Texas! Go! Eat! Grow! Pilot Study

BACKGROUND

The TEXAS! GROW! EAT! GO! (TGEG) randomized, control trial is a 5-year study to measure the impact of a nutrition and gardening intervention and/or physical activity (PA) intervention on the weight status of third-grade students. This article describes the results of the pilot study to test the feasibility of two interventions and test the measures to be used in the main trial.

METHODS

The pilot study was conducted in one school with third-grade students and their parents or guardians. The Junior Master Gardner (JMG) and Walk Across Texas (WAT) interventions were implemented over a 5-month period in three third-grade classrooms during spring 2012. The respective interventions focused on improving healthy eating and PA behaviors of children and their families. Baseline and immediate post-test data were collected from students and parents/guardians to measure four child, four parent, and four parent-child interaction behaviors. Process data regarding implementation were also collected from teachers and school administration.

RESULTS

Forty-four students and 34 parents or guardians provided both pre- and post-test data. Paired-sample t-tests showed statistically significant changes in student knowledge, vegetable preferences, vegetable consumption, and home food availability (all p < 0.05). At baseline, participants' weight status categories included 57% obese, 10% overweight, and 31% normal weight. Postintervention, weight status categories included 39% obese, 16% overweight, and normal 45%. Data collected from teachers indicated high levels of implementation fidelity.

CONCLUSIONS

Implementation of both interventions occurred at a very high fidelity level, which led to positive changes in BMI status, and several dietary and PA behaviors. Although the pilot study indicated feasibility of the two interventions for school implementation, results guided revisions to the TGEG program and its survey instruments.

Adolescents' health identities: a qualitative and theoretical study of health education courses

In this paper we highlight the role of health identity in health education for adolescents. In school-based approaches to health education, it is often difficult to present health information and health communication in ways that make sense and appeal to adolescents. The concept of health identity has the potential of providing an analytical framework as well as practical recommendations for these issues and problem areas. The paper reports on an empirical study of elements of health identity in the context of health courses for adolescents--using interview data, observation studies and a theoretical construction focussing on self-observation, horizons of significance, expectational structures and social imaginaries. We present our findings in four main themes: 1) Adolescents' health identities are observed and developed when things matter, 2) Adolescents' health identities are observed and developed in relational contexts, 3) Adolescents' health identities are developed on the basis of observations of past, present and future health and 4) Adolescents' health identities are clearly defined. The paper provides health practitioners with important knowledge about why and how health-educational approaches should focus on health identity in order to provide conditions that create a significant health educating effect for all adolescents--not just for those who are already healthy.

Religiosity in the non-medical use of prescription medication in college students

BACKGROUND

The non-medical use of prescription drugs (NMUPD) is a hazardous health behavior popular among young adults and college students. Past research has documented prevalence rates and risk factors associated with NMUPD, while little research has addressed protective factors.

OBJECTIVE

The present study examined the associations of religiosity and NMUPD in a sample of college students.

METHODS

Young adult (ages 18-25) college students (n = 767) completed an anonymous online survey assessing demographic variables, NMUPD, personality factors, perceptions of risk, mental health, and religiosity.

RESULTS

Results showed that greater religiosity scores were consistently associated with lower odds of engaging in NMUPD in the past 3 months. These associations were partially mediated by the personality characteristics of conscientiousness and openness to experience as well as perceived risk of NMUPD. The effect of religiosity on NMUPD was moderated by Greek (i.e., fraternity or sorority) membership, such that those in a Greek organization showed no relation between religiosity and NMUPD, while religiosity served as a protective factor for NMUPD among those who did not have Greek membership.

CONCLUSION

These results extend past research demonstrating that religiosity is protective against substance abuse/misuse. Greek status appears to negate the protective influence of religiosity on NMUPD.

Rasmussen K. Authenticity in health education for adolescents: a qualitative study of four health courses

Purpose

– The purpose of this paper is to explore different kinds of authenticity in four health courses for adolescents. In school-based approaches to health education it is often difficult to present health in ways that make sense and appeal to adolescents. Authenticity, as a health-pedagogical concept which focuses on the quality or condition of being believable, trustworthy or genuine, has the potential of providing an analytical framework as well as practical recommendations for this challenge.

Design/methodology/approach

– This was a qualitative study based on 23 group interviews with a total of 114 adolescents and 12 individual interviews with their teachers. The data were iteratively analyzed and categorized using guidelines for content analysis. The study used a theoretical construct focusing on participation, knowledge and health identity, as each of these three elements affects aspects of authenticity when applied to a health education context.

Findings

– The analysis revealed four interdependent categories of authenticity: first, authentic connections/relations; second, authentic instructors; third, authentic themes; and fourth, authentic methods/activities. In each of the four categories the paper presents analytical tools for researchers and practical recommendations for health education professionals.

Originality/value

– The paper presents a new and innovative model with four categories of authenticity that provide health practitioners with important knowledge about why and how health education might wish to focus on authenticity in order to provide conditions that create a significant health educating effect for all adolescents, not just for the ones who are already healthy.

Vulnerability to unhealthy behaviours across different age groups in Swedish Adolescents: a cross-sectional study

Purpose: There is lack of evidence on the effects of health-promoting programmes among adolescents. Health behaviour models and studies seldom compare the underlying factors of unhealthy behaviours between different adolescent age groups. The main objective of this study was to investigate factors including sociodemographic parameters that were associated with vulnerability to health-damaging behaviours and non-adoption of health-enhancing behaviours in different adolescent age groups. Methods: A survey was conducted among 10,590 pupils in the age groups of 13-14, 15-16 and 17-18 years. Structural equation modelling was performed to determine whether health-damaging behaviours (smoking and alcohol consumption) and non-adoption of health-enhancing behaviours (regular meal habits and physical activity) shared an underlying vulnerability. This method was also used to determine whether gender and socio-economic status were associated with an underlying vulnerability to unhealthy behaviours. Results: The findings gave rise to three models, which may reflect the underlying vulnerability to health-damaging behaviours and non-adoption of health-enhancing behaviours at different ages during adolescence. The four behaviours shared what was interpreted as an underlying vulnerability in the 15-16-year-old age group. In the youngest group, all behaviours except for non-participation in physical activity shared an underlying vulnerability. Similarly, alcohol consumption did not form part of the underlying vulnerability in the oldest group. Lower socio-economic status was associated with an underlying vulnerability in all the age groups; female gender was associated with vulnerability in the youngest adolescents and male gender among the oldest adolescents. Conclusions: These results suggest that intervention studies should investigate the benefits of health-promoting programmes designed to prevent health-damaging behaviours and promote health-enhancing behaviours in adolescents of different ages. Future studies should examine other factors that may contribute to the underlying vulnerability in different age groups.

Changing multiple adolescent health behaviors through school-based interventions: a review of the literature

BACKGROUND

In approaches to health promotion in adolescents, unhealthy behaviors are no longer regarded as independent processes, but as interrelated. This article presents a systematic literature review of school-based interventions targeting multiple adolescent behaviors simultaneously.

METHODS

A systematic literature search was performed using PubMed, Science Direct, and PsychInfo. Only papers written in English and describing original research were included.

RESULTS

Of 33 papers included, 23 focused on quantitative behavioral changes, and 10 on the evaluation of intervention development, implementation, and/or institutionalization. Parental and community involvement in the intervention seemed to be positively associated with effective changes in student health behaviors, whereas creating a healthy school environment and/or policies were less strongly associated with intervention effectiveness. Findings indicated that, for adequate implementation, an intervention should be integrated in pre-existent school settings, fine-tuned to its target population or environment, involve family and the community, and be led by the school itself, with there being a "healthy school coordinator" to coordinate the program.

CONCLUSION

A multi-behavior, multi-actor approach would appear to be the most effective way to promote, at school, healthy behaviors among adolescents.

Effects of transfer-oriented curriculum on multiple behaviors in the Netherlands

Many school health promotion curricula address a single health behavior, without paying attention to potential learning effects in associated behavioral domains. We developed an innovative curriculum about smoking and safe sex that also focused on promoting students' transfer of knowledge, skills and attitudes to other domains. In a quasi-experimental study involving 1107 students (Grades 7 and 8) in the Netherlands, the curriculum was compared with regular lessons about smoking and safe sex. The central research questions were to what extent the transfer-oriented curriculum: (i) had effects on psychosocial determinants and behaviors in the domains of smoking and safe sex, (ii) had effects on determinants and behaviors in three domains about which no lessons were taught (consumption of alcohol, fruit and breakfast). Multi-level analyses showed that the answer to both questions is positive. The results indicate that a transfer approach may have surplus value over the classic domain-specific approach and warrant further elaboration in the future.

Results of a multibehavioral health-promoting school pilot intervention in a Dutch secondary school

PURPOSE

Recent studies increasingly show adolescent health-related behaviors to be interrelated, interacting synergistically and sharing several common determinants. Therefore, research increasingly focuses on studying interventions that target a range of health behaviors simultaneously. This report describes the results of a pilot study of a secondary school-based, health-promoting intervention that simultaneously targets a range of adolescent health behaviors via a whole-school approach.

METHODS

We collected self-reported behavioral data via an annual online questionnaire to 336 students. We collected data before the intervention implementation and after the intervention's first completed, 3-year curriculum cycle on the fourth-grade students (15- to 16-year-olds). We analyzed differences between pre- and postintervention groups.

RESULTS

Significant behavioral changes were reported for extreme alcohol use, smoking, sedentary time, and bullying behaviors. Certain behaviors were significantly different only in girls: namely, weekly alcohol use, ever having used cannabis, compulsive Internet or computer use score, compulsive gaming score, and recent bully victimization. Differences in several sedentary time behaviors (television watching and Internet or computer use) were significant only in boys. No changes were reported regarding body mass index; physical activity; or the time spent on, or the compulsiveness of, video game playing. In addition, the postintervention group showed significantly fewer psychosocial problems.

CONCLUSIONS

The intervention successfully changed student health behaviors on many accounts. It remains largely unclear as to what causes the different effects for boys and girls. Further studies regarding multiple health behavior targeting interventions for adolescents are required.

Correlates of delayed sexual intercourse and condom use among adolescents in Uganda: a cross-sectional study

BACKGROUND

Comprehensive sex education, including the promotion of consistent condom use, is still an important intervention strategy in tackling unplanned pregnancies, HIV/AIDS and sexually transmitted infections (STIs) among Ugandan adolescents. This study examines predictors of the intention to use a condom and the intention to delay sexual intercourse among secondary school students (aged 12-20) in Uganda.

METHODS

A school-based sample was drawn from 48 secondary schools throughout Uganda. Participants (N = 1978) completed a survey in English measuring beliefs regarding pregnancy, STIs and HIV and AIDS, attitudes, social norms and self-efficacy towards condom use and abstinence/delay, intention to use a condom and intention to delay sexual intercourse. As secondary sexual abstinence is one of the recommended ways for preventing HIV, STIs and unplanned pregnancies among the sexually experienced, participants with and without previous sexual experience were compared.

RESULTS

For adolescents without sexual experience (virgins), self-efficacy, perceived social norms and attitude towards condom use predicted the intention to use condoms. Among those with sexual experience (non-virgins), only perceived social norm was a significant predictor. The intention to delay sexual intercourse was, however, predicted similarly for both groups, with attitudes, perceived social norm and self-efficacy being significant predictors.

CONCLUSIONS

This study has established relevant predictors of intentions of safe sex among young Ugandans and has shown that the intention to use condoms is motivated by different factors depending on previous sexual experience. A segmented approach to intervention development and implementation is thus recommended.

Study protocol-an exploratory trial on health promoting schools at Dutch secondary schools

Background

Recent studies show adolescent health-related behaviours to co-occur synergistically. This paper describes the study design for an exploratory trial on the effects of a comprehensive, whole-school health promoting school intervention. This intervention tackles seven different behavioural domains simultaneously via a combination of education, creating a healthy environment and introducing healthy behavioural policies. Additionally, extensive partnerships are formed between schools, parents, neighbourhoods and youth health authorities to coordinate health promotion efforts.

Study design and data collection methods

The intervention will be implemented at two secondary schools. Results will be compared with two control schools (n≈1500). The intervention’s effectiveness in changing student behaviours as well as physical and psychosocial health status along with qualitative lessons learned on the integration of youth health care services and school health education practices are the main aimed outcomes of this study. Data are collected via a mixed methods design combining an annual youth health (behaviour) monitor with a qualitative process evaluation via interviews with key stakeholders.

Data analysis

A multilevel analysis is performed combined with a systematic analysis of qualitative interview data.

Conclusions

This study will produce an evaluation of a comprehensive health promoting school intervention that combines an integrated approach of schools, neighbourhoods, families and youth health services to improve adolescent health.

Health-promoting and health-risk behaviors: theory-driven analyses of multiple health behavior change in three international samples

Background

Co-occurrence of different behaviors was investigated using the theoretical underpinnings of the Transtheoretical Model, the Theory of Triadic Influence and the concept of Transfer.

Purpose

To investigate relationships between different health behaviors' stages of change, how behaviors group, and whether study participants cluster in terms of their behaviors.

Method

Relationships across stages for different behaviors were assessed in three studies with N = 3,519, 965, and 310 individuals from the USA and Germany by telephone and internet surveys using correlational analyses, factor analyses, and cluster analyses.

Results

Consistently stronger correlations were found between nutrition and physical activity (r = 0.16–0.26, p < 0.01) than between non-smoking and nutrition (r = 0.08–0.16, p < 0.03), or non-smoking and physical activity (r = 0.01–0.21). Principal component analyses of investigated behaviors indicated two factors: a “health-promoting” factor and a “health-risk” factor. Three distinct behavioral patterns were found in the cluster analyses.

Conclusion

Our results support the assumption that individuals who are in a higher stage for one behavior are more likely to be in a higher stage for another behavior as well. If the aim is to improve a healthy lifestyle, success in one behavior can be used to facilitate changes in other behaviors—especially if the two behaviors are both health-promoting or health-risky. Moreover, interventions should be targeted towards the different behavioral patterns rather than to single behaviors. This might be achieved by addressing transfer between behaviors.

Determinants of children's use of and time spent in fast-food and full-service restaurants

OBJECTIVE

Identify parental and children's determinants of children's use of and time spent in fast-food (FF) and full-service (FS) restaurants.

DESIGN

Analysis of cross-sectional data.

SETTING

Parents were interviewed by phone; children were interviewed in their homes.

PARTICIPANTS

Parents and children ages 9-11 or 13-15 from 312 families were obtained via random-digit dialing.

MAIN OUTCOME MEASURES

Dependent variables were the use of and the time spent in FF and FS restaurants by children. Determinants included parental work schedules, parenting style, and family meal ritual perceptions.

ANALYSIS

Logistic regression was used for multivariate analysis of use of restaurants. Least squares regression was used for multivariate analysis of time spent in restaurants. Significance set at P < .05.

RESULTS

Factors related to use of and time spent in FF and FS restaurants included parental work schedules, fathers' use of such restaurants, and children's time spent in the family automobile.

CONCLUSIONS AND IMPLICATIONS

Parenting style, parental work, parental eating habits and perceptions of family meals, and children's other uses of their time influence children's use of and time spent in FF and FS restaurants.

Strategies to facilitate exposure to internet-delivered health behavior change interventions aimed at adolescents or young adults: a systematic review

The Internet is considered to be a promising delivery channel of interventions aimed at promoting healthful behaviors, especially for adolescents and young adults. Exposure to these interventions, however, is generally low. A more extensive exploration of methods, strategies, and their effectiveness with regard to facilitating exposure is therefore timely, because this knowledge is crucial to improve the use of such interventions and, subsequently, to increase behavioral change. Therefore, a systematic review of the literature was conducted, resulting in 838 studies based on title selection, of which 26 studies met the eligibility criteria. The systematic review resulted in an overview of methods and strategies that have been used to facilitate exposure. Patterns of effective strategies could be observed, such as the combination of tailored communication and the use of reminders and incentives. Nevertheless, exposure-specific theories need to be developed and objective exposure measures should be tracked and reported in future studies.

Parent support, peer support, and peer acceptance in healthy lifestyle for asthma management among early adolescents

PURPOSE

This study aims to investigate the association between social support variables and healthy lifestyle for asthma management among early adolescents (ages 9-14 years).

DESIGN AND METHODS

Questionnaires were completed by 86 parent-adolescent dyads.

RESULTS

Healthy lifestyle was associated with social support variables. The association with peer acceptance was stronger among adolescents who received less asthma-specific support from peers. Age was negatively associated with healthy lifestyle, but the association was attenuated after adjustment for asthma-specific peer support.

PRACTICE IMPLICATIONS

The findings of this study suggest recognizing the developmental change of social support during early adolescence.

Are effects from a brief multiple behavior intervention for college students sustained over time?

OBJECTIVE

This study examined whether 3-month outcomes of a brief image-based multiple behavior intervention on health habits and health-related quality of life of college students were sustained at 12-month follow-up without further intervention.

METHODS

A randomized control trial was conducted with 303 undergraduates attending a public university in southeastern US. Participants were randomized to receive either a brief intervention or usual care control, with baseline, 3-month, and 12-month data collected during fall of 2007.

RESULTS

A significant omnibus MANOVA interaction effect was found for health-related quality of life, p=0.01, with univariate interaction effects showing fewer days of poor spiritual health, social health, and restricted recent activity, p's<0.05, for those receiving the brief intervention. Significant group by time interaction effects were found for driving after drinking, p=0.04, and moderate exercise, p=0.04, in favor of the brief intervention. Effect sizes typically increased over time and were small except for moderate size effects for social health-related quality of life.

CONCLUSION

This study found that 3-month outcomes from a brief image-based multiple behavior intervention for college students were partially sustained at 12-month follow-up.

Effective elements of school health promotion across behavioral domains: a systematic review of reviews

BACKGROUND

Most school health education programs focus on a single behavioral domain. Integrative programs that address multiple behaviors may be more efficient, but only if the elements of change are similar for these behaviors. The objective of this study was to examine which effective elements of school health education are similar across three particular behavioral domains.

METHODS

A systematic review of reviews of the effectiveness of school-based health promotion programs was conducted for the domains of substance abuse, sexual behavior, and nutrition. The literature search spanned the time period between 1995 and October 2006 and included three databases, websites of review centers and backward search. Fifty-five reviews and meta-analyses met predetermined relevance and publication criteria and were included. Data was extracted by one reviewer and checked by a second reviewer. A standardized data extraction form was used, with detailed attention to effective elements pertaining to program goals, development, content, methods, facilitator, components and intensity. Two assessors rated the quality of reviews as strong, moderate or weak. We included only strong and moderate reviews in two types of analysis: one based on interpretation of conflicting results, the other on a specific vote-counting rule.

RESULTS

Thirty six reviews were rated strong, 6 moderate, and 13 weak. A multitude of effective elements was identified in the included reviews and many elements were similar for two or more domains. In both types of analysis, five elements with evidence from strong reviews were found to be similar for all three domains: use of theory; addressing social influences, especially social norms; addressing cognitive-behavioral skills; training of facilitators; and multiple components. Two additional elements had positive results in all domains with the rule-based method of analysis, but had inconclusive results in at least one domain with the interpretation-based method of analysis: parent involvement and a larger number of sessions.

CONCLUSION

Five effective elements of school health promotion were found to be similar across the three behavioral domains examined (substance abuse, sexual behavior, nutrition). An integrative program that addresses the three domains seems feasible. The five elements are primary candidates to include in programs targeting these behaviors.