Combined Patterns of Risk for Problem and Obesogenic Behaviors in Adolescents: A Latent Class Analysis Approach

Determinants of Inequalities in the Exposure to and Adoption of Multiple Health Risk Behaviors among Brazilian Adolescents, 2009-2019

The occurrence of multiple risk behaviors among adolescents imposes challenges in the context of public policies of health, particularly in low- and middle-income countries. Evidence on the conditions leading to the exposure to and adoption of multiple risk behaviors allows the identification of vulnerable groups of adolescents, and may support the proposition of targeted strategies directed to individuals at risk. Therefore, the aim of this study was to perform a quantitative analysis to identify recent trends in the exposure to and adoption of multiple health risk behaviors among Brazilian adolescents, highlighting individual-, household-, and school-level characteristics linked to inequalities among social groups. The analysis was based on cross-sectional data from the National Student Health Survey (PeNSE), conducted by the Brazilian Institute for Geography and Statistics in 2009, 2012, 2015, and 2019. The trends in the occurrence of multiple risk behaviors among adolescents were estimated according to social strata, allowing the calculation of concentration indexes and their disaggregation into major determinants of inequalities in the exposure and adoption of risk behaviors. The analyses were conducted using a complex survey design to allow representativeness at the population level. The results showed a rise in the incidence of multiple risk behaviors among youngsters in Brazil from 2009 to 2019. Factors influencing inequalities in the exposure to multiple risk behaviors were socioeconomic status and the characteristics of the household and school environments, whilst the adoption of multiple risk behaviors was also influenced by early exposure to multiple risk behaviors. Furthermore, trends in inequalities in the exposure to and adoption of multiple risk behaviors showed an intensification from 2009 to 2019, being initially concentrated among wealthier adolescents, followed by a transition to higher incidence in the lower socioeconomic strata in 2012 and 2015, respectively. The findings underscore the role of support systems for adolescents at risk within the familial and school contexts, whereas strategies of public policies of health based on the strengthening of community ties may require improvements to tackle socioeconomic inequalities in the occurrence of risk behaviors among youngsters.

Health literacy and health behaviors in parent-adolescent dyads: an actor-partner interdependence model approach

OBJECTIVE

Health literacy (HL), skills for accessing, appraising and using health information in health decision-making is implicated in adolescents' health behaviors. HL skills develop through scaffolding, modeling, practice and opportunity. Therefore, adolescents' HL skills are likely closely tied to parents' HL and health behaviors. Yet, no studies have examined the dyadic interdependence of the relationship between HL and health behaviors between parents and adolescents. The purpose of this study was to determine the interdependence of adolescents' and parents' HL and health behaviors.

METHODS AND MEASURES

Data were collected from 300 parent-adolescent dyads via Qualtrics Panel. Dyads completed identical measures of their HL, diet, physical activity, sedentary activity, cigarette-smoking, vaping, and alcohol binge-drinking behaviors. Data were analyzed using Pearson correlations and the Actor-Partner Interdependence Model.

RESULTS

Within-dyad correlations were significant for HL and all health behaviors assessed. After controlling for covariates and partner effects, adolescents' HL was related to their sugar-sweetened beverage intake, sedentary activity, and substance use. After controlling for covariates and actor effects, adolescents' HL was related to parents' sedentary activity, binge-drinking, and vaping while parents' HL was related to adolescents' sedentary activity.

CONCLUSION

Our results suggest that there is interdependence in these relationships especially for risk behaviors.

Latent class analysis of health behaviors, anxiety, and suicidal behaviors among Korean adolescents

BACKGROUND

This study examined how health behavior patterns are associated with anxiety and suicidal behaviors among Korean adolescents.

METHODS

Data were collected from a national cross-sectional sample of adolescents (n = 54,948, 51.5 % boys) in the 2020 Korea Youth Risk Behavior Web-based Survey. Latent class analysis was conducted based on 12 health behaviors (e.g., eating habits, physical activity, and substance use) using the R-based Jamovi 2.3.21 program.

RESULTS

Four classes of health behaviors were identified: Class 1 (boys: 45.4 %, girls: 34.4 %) engaged in healthy behaviors; Class 2 (boys: 31.7 %; girls: 22.3 %) had unhealthy eating habits; Class 3 (boys: 18.0 %; girls: 39.9 %) had the lowest physical activity; and Class 4 (boys: 5.0 %, girls: 3.4 %) engaged in substance use, including smoking, drinking, and problematic smartphone use. Overall, girls had a higher odds ratio (OR) for anxiety and suicidal behaviors than boys did. Among girls, Class 4 had a higher OR for anxiety (OR = 2.78, 95 % confidence interval [CI] = 2.40-3.21), suicidal ideation (OR = 3.99, 95 % CI = 3.46-4.62), suicide plan (OR = 3.32, 95 % CI = 2.66-4.16), and suicide attempts (OR = 5.62, 95 % CI = 4.43-7.12) than Class 1.

LIMITATIONS

This study has a few limitations including the participants' response bias, the use of a self-report survey, and the lack of diagnosis by clinicians.

CONCLUSION

Adolescents engaging in substance abuse (Class 4) were more prone to anxiety symptoms and suicidal behaviors (ideation, plan, and attempts) than those engaged in healthy behaviors (Class 1). We suggest that more attention is needed to develop suicide prevention strategies that consider adolescent substance use patterns such as current smoking, drinking, and problematic smartphone use.

Mediation of the association between screen time and suicidality by overweight/obesity and perceived overweight: results from the youth risk behavior surveillance system of the United States

Aim

Adolescent suicide is a major public health concern, and modifiable risk factors associated with adolescent suicide remain poorly understood. This study aimed to assess the association between screen time and overweight/obesity and self-perceived overweigh and suicidality in adolescents.

Methods

Adolescents from the United States Youth Risk Behavior Surveillance System (YRBSS) between 2013 and 2019 were included in this cross-sectional study. The outcome was suicidality, including considered suicide, made a suicide plan, attempted suicide, and injurious suicide attempt. Multivariable logistic regression model was used to investigate the associations between screen time, overweight/obesity, self-perceived overweight, and suicidality, and expressed as odds ratio (OR) and 95% confidence interval (CI). Mediation analysis was used to explore the role of overweight/obesity and self-perceived overweight on the association between screen time and suicidality.

Results

A total of 30,731 adolescents were included, of which 6,350 (20.65%) had suicidality, including 5,361 (17.45%) with considered suicide, 4,432 (14.42%) with made a suicide plan, 2,300 (7.45%) with attempted suicide, and 677 (2.21%) with injurious suicide attempt. Adolescents with screen time ≥3h were related to higher odds of suicidality (OR=1.35, 95%CI: 1.23-1.46), overweight/obesity (OR=1.27, 95%CI: 1.19-1.38), and self-perceived overweight (OR=1.38, 95%CI: 1.30-1.48) after adjusting confounders. Adolescents with overweight/obesity (OR=1.30, 95%CI: 1.19-1.43) and self-perceived overweight (OR=1.54, 95%CI: 1.39-1.70) were associated with higher odds of suicidality. The association between screen time and suicidality was 4.67% mediated by overweight/obesity and 9.66% mediated by self-perceived overweight. Moreover, the mediating role of overweight/obesity was observed only in females, whereas there were no sex differences in the mediating effect of self-perceived overweight.

Conclusion

Both overweight/obesity and self-perceived overweight mediated the association between screen time and suicidality.

The association of weight control attempts with suicidality: The role of objective weight status and weight perception among adolescents of United States

BACKGROUND

The evidence for the association of weight control attempts with suicidality by objective weight status, subjective weight perception, and distorted weight perception among adolescents was limited.

METHODS

Data were extracted from a national representative sample of Youth Risk Behavior Surveys in the United States from 2011 to 2019. Binary logistic regression models with complex sampling designs were used to explore the association of weight control attempts, objective weight status, and weight perception with suicidality.

FINDINGS

The adolescents attempting to lose weight had higher weighted prevalence of suicidal ideation, suicide plan, suicide attempt, and suicide attempt with medical treatment compared with other attempts of weight control. Totally, attempting to lose weight was significantly associated with increased risk of suicidal ideation (OR: 1.17, 95%CI: 1.05-1.30) and suicide attempt (OR: 1.26, 95%CI: 1.10-1.46) when adjusting objective weight status, weight perception and all other covariates. In the subgroup analyses, attempting to lose weight was significantly associated with increased risk of suicidality in the adolescents of normal weight, underweight, perceived normal weight, perceived underweight, right estimation of objective weight status.

LIMITATIONS

Uncertain causal relationship existed because of cross-sectional design.

CONCLUSIONS

The risk of suicidality associated with weight control attempts varied among different subgroups. The findings in this study suggest that not only objective weight status but also weight perception should be with consideration when performing weight control attempts.

Clustering of Activity-Related Behaviors in Relation to Self-Reported Causes of Stress among Pre-Adolescents: Results from a National Epidemiological Study

An epidemiological study was conducted among 1728 10–12-year-old students (55.1% girls) and their parents during 2014–2016 in Greece. This study aimed to identify the dominant clusters of physical activity/sedentariness among preadolescents and investigate their association with self-reported sources of stress. Children’s physical activity levels and sources of stress were evaluated using validated questionnaires that assessed daily hours of activities, both on weekdays and on weekends, including physical activity, screen-based sedentary time, and non-screen-based sedentary time. The k-means algorithm of cluster analysis was applied. Three clusters of children’s physical activity/sedentariness were revealed. Cluster 1 was characterized as “Inactive-Non sedentary”, cluster 2 as “Active –Non-screen sedentary”, and cluster 3 as “Inactive-Sedentary”. Parental needs/expectations were associated with physical activity patterns (p = 0.009), i.e., children assigned to the third and second clusters had 36% and 51% lower odds to be stressed due to parental requirements [(OR for cluster 3 = 0.64, 95% CI = 0.41–0.99), (OR for cluster 2 = 0.49, 95% CI = 0.32–0.76)], compared with their first-cluster counterparts. Considering the need to promote physical activity in early life stages, the identification of these complex activity-related patterns along with their significant interaction with parental expectations as a cause of stress could enhance the effectiveness of targeted behavior change interventions among those parent–child dyads most in need.

Factors Related to High-School Students’ Odds of Having Overweight or Obesity

This study used data the Youth Risk Behavior Surveillance System ( N = 7,088) to examine factors associated with the odds of overweight/obesity. Overweight/obese was defined as a body mass index ≥85th percentile, based on age- and sex-specific growth charts. Participants were categorized into meeting/not meeting guidelines for: sleep, moderate-to-vigorous PA (MVPA), muscle strengthening PA, screen time, breakfast eating, fruit and vegetable consumption, and soda and milk consumption. Logistic regression analyses determined whether meeting guidelines for each health behavior was associated with the odds of students having overweight/obesity in the total group and stratified by sex. Meeting MVPA guidelines was the only behavior associated with having a lower odds of overweight/obesity in both sexes. For females, meeting recommendations for breakfast eating and strength training were also associated with lower odds of having overweight/obesity, whereas for boys, getting the recommended amount of sleep was associated with having lower odds of overweight/obesity. Interventions to reduce the prevalence of overweight/obesity in youth should be implemented inside and outside of the school environment and should include components addressing physical activity, diet, and sleep. Such interventions should address barriers to healthy behaviors that are unique to adolescents already affected by overweight/obesity.

Racial/Ethnic Differences in Chronic Disease Predictors Among American High School Students

BACKGROUND

Few studies have attempted to define clusters of chronic disease predictors with additional focus on racial/ethnic differences. The purpose of this study was to highlight differences in predictors of chronic diseases among American high school students by identifying subgroups using latent class analysis (LCA).

METHODS

The chronic disease predictor variable used in the analysis was created from 5 modified items in the 2019 Youth Risk Behavior Surveillance that were identified to be critical to healthy lifestyles in Healthy People 2020. Descriptive, bivariate, multinomial logistic regression and LCA were performed using SAS 9.4 and Mplus in 9th to 12th grade students, using data from the Youth Risk Behavior Survey (N = 13,677).

RESULTS

Three distinct classes emerged for US high school students and were characterized as high, moderate, and low risk of chronic disease (38%, 33%, and 29%, respectively). Black and Asian students had a higher chance of being in the high-risk class of chronic diseases.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Emphasis should be placed on sociocultural and socio-environmentally structured prevention programs for at risk/students, ensuring that policy formation reflects the language, identity, and needs of the populations at risk.

CONCLUSIONS

The behavioral similarities of the classes identified highlight the need for continued research, novel interventions, and culturally sensitive strategies and policies in US high schools.

Soft drink consumption and depressive symptoms among the adolescents of United States: The mediating role of aggressive behaviors

BACKGROUND

There is limited evidence for the association among soft drink consumption, aggressive behaviors, and depressive symptoms among the adolescents.

METHODS

Data were derived from a national representative sample of Youth Risk Behavior Surveys of United States during 2011 to 2019. Binary logistic regression models with complex sampling design were used to estimate the effect of soft drink consumption on aggressive behaviors and depressive symptoms. Mediating analysis was used to explore the association between soft drink consumption and depressive symptoms by aggressive behaviors.

FINDINGS

The total prevalence of depressive symptoms was 3l.2 % (30.3 %-32.0 %). Compared with none of soft drink consumption, <1 time/day (OR: 1.29, 95%CI: 1.19-1.41), 1-2 times/day (OR: 1.49, 95%CI: 1.33-1.67), and ≥3 times/day (OR: 1.95, 95%CI: 1.70-2.24) were significantly associated with increased risk of aggressive behaviors. High levels of soft drink consumption (1-2 times/day, OR: 1.19, 95%CI: 1.07-1.32; ≥3 times/day, OR: 1.61, 95%CI: 1.42-1.81) and aggressive behaviors (OR: 1.98, 95%CI: 1.84-2.13) were found to be significantly associated with increased risk of depressive symptoms. A linear dose-response relationship of soft drink consumption with aggressive behaviors and depressive symptoms was found in this study (all p < 0.001). Aggressive behaviors partially mediated the association between soft drink consumption and depressive symptoms and each pathway was statistically significant.

LIMITATIONS

The causal relationship was not able to certain because of the cross-sectional design.

CONCLUSIONS

The mediating role of aggressive behaviors on the association of high levels of soft drink consumptions with depressive symptoms should be paid more attention among the adolescents.

The Association of Soft Drink Consumption and the 24-Hour Movement Guidelines with Suicidality among Adolescents of the United States

Background: Evidence is lacking for the association of the behaviors of the 24 h movement guidelines including sleep duration, physical activity, screen time, and soft drink consumption with suicidality among adolescents. Methods: Data were extracted from a national representative sample of Youth Risk Behavior Surveys (YRBS) in the United States from 2011 to 2019. Binary logistic regression models with complex sampling designs were used to explore the association of the recommendations of the 24 h movement guidelines and soft drink consumption with suicidality. Results: The total prevalence of suicidal ideation, suicide plan, suicide attempt, and suicide attempt with medical treatment was higher among adolescents who did not meet all the recommendations in the 24 h movement guidelines and had a higher level of soft drink consumption. Totally, not meeting all the recommendations of the 24 h movement guidelines was significantly associated with an increased risk of suicidal ideation (OR: 1.69, 95% CI: 1.30–2.19) and suicide plan (OR: 1.76, 95% CI: 1.34–2.33) compared with adolescents who meet all the recommendations. Soft drink consumption of ≥3 times/day was associated with an increased risk of suicidality including suicidal ideation, suicide plan, suicide attempt, and suicide attempt with medical treatment, regardless of sex. Soft drink consumption of ≥3 times/day was significantly associated with an increased risk of suicide attempt and suicide attempt with medical treatment, regardless of whether the recommendations of physical activity, screen time, and sleep duration were met. Conclusion: Age-appropriate sleep duration, no more than 2 h of screen time per day, at least 1 h of physical activity per day as contained in the 24 h movement guidelines and less than one soft drink consumption per day are good targets to prevent involvement in suicidality. More actions for intervening in the movement and dietary behaviors among adolescents are needed to maintain physical and mental health.

Association of Weight Perception, Body Satisfaction, and Weight Loss Intention With Patterns of Health Risk Behaviors in Adolescents With Overweight and Obesity

Obesity is a public health issue and childhood is a critical window in which to establish healthy eating patterns and modify risk factors for overweight. This study aims to verify the association of weight perception, body satisfaction, and weight loss intention with patterns of health risk behaviors in adolescents with overweight and obesity. We analyzed health risk behavior from a school-based national survey conducted in 2015 in Brazil (n = 2,703 students with overweight or obesity, aged 13-17 years). We performed latent class analysis of alcohol consumption, tobacco use, physical activity, screen time, and eating habits for adolescents with overweight and identified four distinct health behavior patterns. The association of these patterns with weight perception, body satisfaction, and weight loss intention was analyzed through multinomial logistic regression. Adolescents who perceived themselves as "fat" or "very fat" were more likely to have a sedentary lifestyle and low consumption of fruit and vegetables. Body satisfaction was a protective factor against sedentary lifestyle. Students who reported weight loss intention were less likely to be in high-health-risk behavior groups (low consumption of fruit and vegetables; sedentary lifestyle; tobacco and alcohol use). Self-perception as overweight had detrimental associations, while body satisfaction was a protective factor for a healthy lifestyle. Weight loss intention still requires rigorous analysis due to inconsistencies in the literature. The complexity of the relationship between body image and obesity needs to be highlighted. Multicomponent strategies are required to control the global obesity pandemic.

The Serial Mediation of the Association between Breakfast Skipping and Suicidality by Weight Status and Depressive Symptoms: Findings from the National Youth Risk Behavior Surveys of the United States

Background: The evidence is limited for the dose–response association between breakfast skipping and suicidality. The underlying pathway from breakfast skipping to suicidality has also rarely been explored in previous studies. Methods: The data of Youth Risk Behavior Surveys (YRBSs) of the United States from 2011 to 2019 were used with a sample size of 74,074. The male: female ratio was nearly 1:1. Binary logistic regression models with complex sampling design were adopted to show the effect of breakfast skipping on weight status, depressive symptoms, and suicidality. Serial mediation was used to explore the association between breakfast skipping and suicidality by overweight/obesity and depressive symptoms. Findings: The weighted prevalence rates (95% confidence interval) of suicidal ideation, suicide plan, suicide attempt, and medically serious suicide attempt for skipping breakfast totally (0 times/week) were 25.6% (24.4–26.8%), 21.7% (20.5–22.9%), 14.2% (13.0–15.3%), and 5.3% (4.6–5.9%). Breakfast skipping was significantly associated with increased risk of suicidal ideation, suicide plan, suicide attempt, and medically serious suicide attempt. There was statistical significance for the linear dose–response association between breakfast skipping and overweight/obesity, depressive symptoms, and suicidality regardless of sex and age. A serial mediation with effect sizes between 39.68% and 51.30% for the association between breakfast skipping and suicidality by overweight/obesity and depressive symptoms was found in this study. Conclusions: This study emphasizes the hazards of breakfast skipping, which could increase the risk of suicidality among adolescents. Overweight/obesity and depressive symptoms as the mediating factors for the association between breakfast skipping and suicidality should also be with more attention.

Latent Class Analysis of Obesogenic Behaviors among Korean Adolescents: Associations with Weight-Related Outcomes

This study aimed to explore sex-specific latent class models of adolescent obesogenic behaviors (OBs), predictors of latent class membership (LCM), and associations between LCM and weight-related outcomes (i.e., weight status and unhealthy weight control behaviors). We analyzed nationally representative data from the 2019 Korea Youth Risk Behavior Survey. To identify latent classes for boys (n = 29,841) and girls (n = 27,462), we conducted a multiple-group latent class analysis using eight OBs (e.g., breakfast skipping, physical activity, and tobacco product use). Moreover, we performed a multinomial logistic regression analysis and a three-step method to examine associations of LCM with predictors and weight-related outcomes. Among both sexes, the 3-class models best fit the data: (a) mostly healthy behavior class, (b) poor dietary habits and high Internet use class, and (c) poor dietary habits and substance use class. School year, residential area, academic performance, and psychological status predicted the LCM for both sexes. In addition, perceived economic status predicted the LCM for girls. The distribution of weight-related outcomes differed across sex-specific classes. Our findings highlight the importance of developing obesity prevention and treatment interventions tailored to each homogeneous pattern of adolescent OBs, considering differences in their associations with predictors and weight-related outcomes.

Clustering of Physical Activity, Diet and Sedentary Behavior among Youth from Low-, Middle-, and High-Income Countries: A Scoping Review

Background: The interaction between physical activity (PA), diet, and sedentary behavior (SB) plays an important role on health-related outcomes. This scoping review (Prospero CRD42018094826) aims to identify and appraise clusters of PA, diet, and SB among youth (0–19 years) according to country income. Methods: Five databases were searched. Fifty-seven articles met the inclusion criteria. Results: Fifty-five cluster types were identified, with greater variety in high-income than lower income countries. The most prevalent profiles were “High SB and consumption of sugar, salt, and beverages (SSB)” (n = 17) and “High PA” (n = 13–5), both of which presented in all income countries. The healthiest profile, “High PA and fruit and vegetables (F&V); Low SB and SSB” (n = 12), was present in upper-middle and high-income countries, while the unhealthiest “Low PA and F&V; High SB and SSB” (n = 6) was present only in high-income countries. Conclusions: High SB and unhealthy diet (SSB) were more prevalent in clusters, mainly in high-income countries. The results support the need for multi-component actions targeting more than one behavior at the same time.

Associations between Movement Behaviours and Obesity Markers among Preschoolers Compliant and Non-Compliant with Sleep Duration: A Latent Profile Analysis

This study identifies physical activity (PA) and sedentary behaviour (SB) clusters in preschoolers compliant (C) or non-compliant (NC) with sleep recommendations; and associates these clusters with obesity markers. PA and SB were objectively assessed (Actigraph WGT3-X) in 272 preschoolers (4.4 ± 0.7 years old). Sleep duration was parent-reported, and preschoolers were classified as C (3-4 years old: 600-780 min/day; 5 years old: 540-660 min/day) or NC with sleep recommendations. Body mass index (BMI) and waist circumference (WC) were assessed according to international protocols. Moderate to vigorous physical activity (MVPA) and light physical activity (LPA) were categorized as low/high (<60 min/>60 min/day or <180 min/180 min/day, respectively). SB was defined according to mean values between clusters. Latent profile analysis was performed. Associations between the observed clusters and obesity markers were determined using linear regression (RStudio; 1.3.1073). Four cluster solutions for C and NC preschoolers were identified. A negative association between C/Low MVPA cluster and BMI, and a positive association between NC/Low MVPA and BMI (β = -0.8, 95%CI = -1.6;-0.1, and β = 0.9, 95%CI = 0.1;1.7, respectively) were observed. No association was seen for SB clusters. Adequate sleep duration may have a protective role for preschoolers' BMI, even if the children do not comply with MVPA recommendations.

"The Way you Interpret Health": Adolescent Definitions and Perceptions of Health Literacy

BACKGROUND

Adolescents are required to take increased responsibility for their health. Although health literacy is implicated in adults' health decision-making and health behaviors, little is known about adolescents' health literacy and its relationship to their health behaviors. Furthermore, adolescent health literacy research overlooks adolescent development-specific needs and skills. Therefore, we qualitatively explored adolescents' (1) definitions of health literacy, preventive health behaviors, and health risk behaviors; and (2) perception of the health literacy/health behavior relationship.

METHODS

Six semi-structured focus groups were conducted with adolescents (N = 37) who answered questions about their perceptions of health literacy, preventive health behaviors, and health risk behaviors. Focus groups were coded using thematic analysis. Themes representing adolescents' definitions of health literacy were secondarily coded for alignment with definitions in the literature.

RESULTS

Some of adolescents' health literacy definitions aligned with the adult health literacy literature. They considered health literacy a tool for informed decision-making, but acknowledged not always using these skills.

CONCLUSIONS

Adolescents' definitions of health literacy were multidimensional, going beyond numeracy and literacy skills. Developmental characteristics and adolescents' definition of health risk behaviors were related to use of health literacy skills. Opportunities for adolescents to develop and practice health literacy skills are discussed.

Health-Related Behaviors in Adolescents Mediate the Association between Subjective Social Status and Body Mass Index

The aim of this study was to explore the association between adolescent subjective social status (SSS) and body mass index (BMI) at two different time points and to determine whether this association was mediated by health-related behaviors. In 2002 (n = 1596) and 2017 (n = 1534), tenth-grade students (15-16 years old) in schools in the District of Oppland, Norway, completed a survey. Four categories of perceived family economy were measured as SSS, and structural equation modeling was performed, including a latent variable for unhealthy behavior derived from cigarette smoking, snuff-use, and alcohol-drinking as well as dietary and exercise as mediators. No linear association was found between SSS and BMI in 2002 (standardized ß -0.02, (95% confidence interval (CI) -0.07, 0.03)). However, an association was present in 2017 (standardized ß -0.05 (95% CI -0.10, -0.001)), indicating that BMI decreased by 0.05 standard deviations (0.05 × 3.1 = 0.16 BMI unit) for every one-category increase in SSS. This association was mediated by exercise (standardized ß -0.013 (95% CI -0.02, -0.004) and unhealthy behavior (standardized ß -0.009 (95% CI -0.002, -0.04)). In conclusion, a direct association between SSS and BMI was found in 2017 in this repeated cross-sectional survey of 15-16-year-old Norwegian adolescents. This association was mediated through health-related behavior.

Healthy lifestyles among military active duty service members, and associations with body-building and weight-loss supplement use

PURPOSE

The purpose of this study was to characterize health behavior profiles among active duty service members and associate these profiles with body-building and weight-loss dietary supplement (DS) use.

METHODS

Based on U.S. active duty service members who completed the 2011 Health-Related Behavior Survey (n = 39,877), we used latent class analysis to place respondents into latent classes (using healthy/unhealthy food consumption, aerobic activity, strength training, and sleep) and examined associations between latent class and DS use.

RESULTS

We identified seven health behavior classes that could be classified by physical activity and diet. Three classes with high activity were further characterized by healthy diet (24%); few unhealthy foods (18%); and unrestricted diet (9%). Three classes with low activity were further characterized by restricted diet (15%), healthy diet (15%), and unhealthy diet (6%). The last class (13%) reported moderate levels of all behaviors. The classes did not vary by sleep. Participant characteristics across most classes were relatively homogenous along demographics and military branch. The active classes had relatively higher usage of body-building and weight-loss DSs.

CONCLUSIONS

Latent classes from health behavior indicators might be considered "market segments", which can be targeted with distinct messaging. Service members appear to consume DSs as part of an otherwise healthy lifestyle.

Latent class analysis of obesity-related characteristics and associations with body mass index among young children

OBJECTIVE

Identifying how obesity-related characteristics cluster in populations is important to understand disease risk. Objectives of this study were to identify classes of children based on obesity-related variables and to evaluate the associations between the identified classes and overweight and obesity.

METHODS

A cross-sectional study was conducted among children 3-11 years of age (n = 5185) from the TARGet Kids! network (2008-2018). Latent class analysis was used to identify distinct classes of children based on 15 family, metabolic, health behaviours and school-related variables. Associations between the identified latent classes and overweight and obesity were estimated using multinomial logistic regression.

RESULTS

Six classes were identified: Class 1: 'Family and health risk behaviours' (20%), Class 2: 'Metabolic risk' (7%), Class 3: 'High risk' (6%), Class 4: 'High triglycerides' (21%), Class 5: 'Health risk behaviours and developmental concern' (22%), and Class 6: 'Healthy' (24%). Children in Classes 1-5 had increased odds of both overweight and obesity compared with 'Healthy' class. Class 3 'High risk' was most strongly associated with child overweight (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.2, 3.2) and obesity (OR 3.3, 95% CI 1.7, 6.7).

CONCLUSIONS

Distinct classes of children identified based on obesity-related characteristics were all associated with increased obesity; however, the magnitude of risk varied depending on number of at-risk characteristics. Understanding the clustering of obesity characteristics in children may inform precision public health and population prevention interventions.

Clusters of non-dietary obesogenic behaviors among adolescents in Brazil: a latent profile analysis

OBJECTIVES

To identify patterns of non-dietary obesogenic behaviors, and social and environmental factors associated with overweight and obesity (OWOB).

METHODS

A representative sample (n = 5520) of high school students (55.4% girls, 16.3 ± 1.0 years) from Pernambuco State, Brazil. Latent profile analyses were performed using self-reported daily sleep duration, television use, computer use, videogame use, seated time during the week and weekend days, physical activity, and active commuting to school during the week. Social and environmental factors and body mass index were included to identify classes. Multinomial analysis explored differences in social, environmental factors, and BMI by classes.

RESULTS

Five patterns were identified [Computer users (C1), Short sleepers (C2), Typical behaviors (C3), Techno-active-gamers (C4), and Lower screen engagement (C5)]. Three groups (C1, C3 and C4) included students from better social conditions and a more urbanized environments. The prevalence of OWOB was higher in C1 (34.5%; 95% CI 31.1-38.0) and in C2 (29.7%; 95% CI 26.1-33.5) compared to C5 (23.3% 95% CI 21.3-25.3).

CONCLUSIONS

In one of the poorest regions of Brazil, different groups of social/environmental factors and behavior patterns emerged associated with OWOB.

Behavioral classes related to physical activity and sedentary behavior on the evaluation of health and mental outcomes among Brazilian adolescents

Latent Class Analysis can assist researchers interested in a better understanding of behavioral patterns and their association with health outcomes. This study aimed to identify lifestyle latent classes related to distinct domains of physical activity (PA) and sedentary behavior (SB) among adolescents and their association with health outcomes. This cross-sectional study included 217 Brazilian adolescents (15 to 18 years old, 49.3% female). The classes were based on moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), number of steps, sedentary behavior (SB), and screen time (ST). To assess these behaviors, participants wore an accelerometer for one week. ST, demographic characteristics, socioeconomic status, and signs of common mental disorders (CMD) were evaluated through questionnaires. Latent Class Analysis was used to identify lifestyle classes. Three classes were recognized: “Active—Non-sedentary” (class 1) with 28.1% of adolescents; “Inactive—Non-sedentary” (class 2), 48.85%; and “Inactive—Sedentary” (class 3), 23.04%. Sex and signs of CMD were associated with the prevalence of the classes. Female adolescents presented 4.48 (95% CI 2.04–9.77) times more chance of belonging to the “Inactive—Sedentary” (class 3). Adolescents who presented CMD had 11.35 (95% CI 3.45–101.1) times more chance of belonging to the “Inactive—Non-sedentary” (class 2). The interaction between sex and signs of CMD showed that girls with signs of CMD were 9.20 (95% CI 1.17–71.52) more likely to belong to the Inactive—Sedentary class than the “Active—Non-sedentary”. Results indicate that sex and signs of CMD can affect the prevalence of the classes. Our findings highlight that physical inactivity and SB can be associated with signs of CMD, especially in female adolescents.

Psychosocial factors and multiple health risk behaviors among early adolescents: a latent profile analysis

Early adolescence is a pivotal developmental period when multiple health risk behaviors, such as obesity and substance use, are often established. Several psychosocial factors, often considered traits, have been independently associated with these increases, including executive function (EF), mindfulness disposition (MD), perceived stress, distress tolerance (DT), and anhedonia. However, these factors have not been evaluated for their conjoint relationships to determine whether different patterns may signal greater or lesser risk for obesity and substance use, and whether the same patterns relate to obesity and substance use in the same ways (same magnitude of risk). To evaluate these patterns, a latent profile analysis was conducted, resulting in a three-profile model. Profile 1 (8% of sample) was characterized by the lowest levels of EF, MD, DT and highest levels of stress and anhedonia, profile 2 (44%) intermediate levels, and profile 3 (48%) the highest levels of EF, MD, DT and lowest levels of stress and anhedonia. Youth classified to profile 1 reported significantly greater levels of both obesogenic and substance use behaviors relative to other profiles. Findings suggest that adolescents engaging in obesogenic and substance use behaviors may share common profiles of psychosocial risk.

Healthy or Unhealthy? The Cocktail of Health-Related Behavior Profiles in Spanish Adolescents

The aim of this study was to identify the prevalence and clustering of health-related behaviors in Spanish adolescents and to examine their association with sex, body mass index (BMI), different types of sedentary screen time, and adherence to 24-hour movement guidelines. A final sample of 173 students (M = 12.99 ± 0.51) participated in this study. Cluster analysis was conducted based on five health-related behaviors: PA and sedentary time derived from accelerometers, as well as healthy diet, sedentary screen time, and sleep duration derived from self-reported scales. Recommendations for 24-hour movement guidelines (i.e., physical activity (PA), screen time, and sleep duration) were analyzed both independently and combined. A total of 8.9% of the sample did not meet any of the guidelines, whereas 72.3%, 17.3%, and 1.7% of the sample met 1, 2, or all 3 guidelines, respectively. Six distinct profiles were identified, most of them showing the co-occurrence of healthy- and unhealthy-related behaviors. Given that most of the adolescents failed to meet the combination of PA, screen time, and sleep duration guidelines, these findings suggest the necessity to implement school-based interventions that target multiple health behaviors, especially because (un)healthy behaviors do not always cluster in the same direction.

Personalizing the Dietary Guidelines: Use of a feedback report to help adolescent students plan health behaviors using a SMART goal approach

BACKGROUND

School health curricula should help students choose health goals related to the Dietary Guidelines (DG) recommendations addressing obesity. We aimed to identify characteristics associated with choice of DG recommendation items.

METHODS

In 12 HealthCorps affiliated high schools, students completed a 19-item web-based questionnaire that provided a personalized health-behavior feedback report to guide setting SMART (Specific, Measurable, Action-oriented, Realistic, Time-bound) goals. We examined if gender, weight-status, and personalized feedback report messages were related to student-selected SMART Goals.

RESULTS

The most frequent SMART Goals focused on breakfast (22.4%), physical activity (21.1%), and sugary beverages (20.4%). Students were more likely to choose a SMART goal related to breakfast, sugary beverages, fruit/vegetable intake or physical activity if their feedback report suggested that health behavior was problematic (p<0.0001). Males were more likely than females to set sugary beverage goals (p<0.05). Females tended to be more likely than males to set breakfast goals (p=0.051). Students, who had obesity, were more likely than normal weight students to set physical activity goals (p<0.05).

CONCLUSION

SMART goals choice was associated with gender and weight status. SMART goal planning with a web-based questionnaire and personalized feedback report appears to help students develop goals related to the Dietary Guidelines recommendations.

A latent class analysis of health lifestyles and suicidal behaviors among US adolescents

BACKGROUND

Previous studies have documented the link between individual health behaviors and suicide, but little is known about the influence of health lifestyles on suicide among adolescents. This study aims to identify the unobserved patterns of health behaviors and to examine their associations with adolescent suicidal behaviors to inform screening of suicidality.

METHODS

Data were derived from a nationally representative sample of adolescents (n = 14,506, ages 12-18, 50.9% female) in the national school-based 2017 Youth Risk Behavior Survey. Latent class analysis was performed based on 13 health behaviors related to diet (e.g., frequency of consuming breakfast, fruits/vegetables, soda), physical activity (frequencies of physical activity, sports team participation), sleep, and media use (TV/computers). Suicidal behaviors were measured by three dichotomized variables, including suicidal ideation, plan, and attempts. Multivariate logistic regressions were used to examine associations between identified classes and suicidal behaviors.

RESULTS

Four classes of health lifestyles were identified. Class 1 (23.6%) consistently engaged in health-promoting behaviors, including eating breakfast daily, high intake of fruits/vegetables, physically active, and infrequent use of TV/computers. Class 2 (37.7%) had an irregular diet, moderate exercise, and high computer use. Class 3 (31.8%) had moderate diet, frequent exercise, and moderate sleep. Class 4 (6.9%) had the lowest engagement in health-promoting behaviors. Class 4 had higher odds of suicide plan than Class 1 (OR = 1.50, 95% CI = 1.10-2.05). Notably, Class 2 and 3 were less likely to attempt suicide than Class 1 (OR = 0.74, 95% CI = 0.57-0.95 for Class 2; OR = 0.65, 95% CI = 0.48-0.89 for Class 3).

LIMITATIONS

Due to the cross-sectional design, no causal inference can be drawn.

CONCLUSIONS

Both Class 1 (consistent) and Class 4 (lowest) engagement in health-promoting behaviors were associated with increased suicidal behaviors. Suicide prevention efforts that examine both lifestyles are keys to early detection of suicidal ideation and plans, and prevention of suicide attempts.

Activity-related behavior typologies in youth: a systematic review

BACKGROUND

Clusters of adolescents differentiated by patterns of physical activity and sedentary behavior (activity-related typologies) are common. Understanding both the characteristics of adolescents and modifiable correlates of these typologies, can help to develop interventions for those most at risk. This systematic review aimed to synthesize the socio-demographic characteristics and modifiable correlates of activity-related behavioral typologies among adolescents.

METHODS

A systematic search of seven electronic databases was conducted to identify quantitative studies using person-oriented statistical approaches to identify activity-related behavioral typologies among 12-18 year-olds. This systematic review was registered in Prospero (registration number: CRD42016046879).

RESULTS

Thirty-six studies met the inclusion criteria and were classified according to three sub-themes based on behaviors included in the typologies (1. physical activity and sedentary behavior only; 2. physical activity, sedentary behavior and risk-related behaviors; 3. physical activity, sedentary behavior and diet). Studies were mostly cross-sectional and relied on self-report measures. Methods were considerably heterogeneous, however results revealed some consistency in typologies within specific groups. For example, typologies characterized by unhealthy behavior patterns (e.g., characterized by physical inactivity, high sedentary behavior and poor diet or high risk-related behaviors) comprised more older adolescents. With the exception of socio-demographics (age, sex, body mass index and socio-economic status), very few correlates have been studied to date (mostly school-related behavioral factors and intrapersonal influences), with evidence largely from typologies comprised of physical activity, sedentary behavior and diet.

CONCLUSIONS

More research is needed to assess a range of modifiable correlates associated with activity-related behavior typologies among adolescents. This will allow for more targeted interventions, to achieve long-lasting, positive behavior change in adolescent populations.

Determinants of racial/ethnic disparities in disordered sleep and obesity

Racial/ethnic minorities experience a disproportionate risk of both suboptimal sleep and obesity, and the relationship between sleep and obesity may differ by race/ethnicity for modifiable and non-modifiable reasons. Because many people of color have historically lived and continue to largely live in disadvantaged, obesogenic physical and social environments, these greater adverse exposures likely negatively affect sleep, resulting in physiological dysregulation. Physiological dysregulation may, in turn, lead to increased obesity risk and subsequent health consequences, which are likely more influential than potential genetic differences in race, a social construct. The purpose of this article is to describe potential environmental, genetic, and epigenetic determinants of racial/ethnic differences in the sleep-obesity relationship and to review current epidemiological findings regarding either racial/ethnic minority specific estimates of the association or disparities in the relationship. Using the socioecological framework as a conceptual model, I describe sleep and obesity as socially patterned and embedded in modifiable physical and social contexts with common causes that are influenced by upstream social conditions. I also provide examples of sleep and obesity-related studies that correspond with the downstream, intermediate, and upstream factors that likely contribute to commonly observed racial/ethnic disparities in the sleep-obesity relationship. The review concludes with broad recommendations for (1) advancing research methodology for epidemiological studies of disparities in the link between sleep and obesity, (2) future research topics, as well as (3) several broad policies and structures needed to address racial/ethnic disparities in sleep health and obesity.