School-Level Socioeconomic Status Influences Adolescents' Health-Related Lifestyle Behaviors and Intentions

School health promotion and the consumption of water and sugar-sweetened beverages in secondary schools: a cross-sectional multilevel study

BACKGROUND

Overweight among adolescents remains a serious concern worldwide and can have major health consequences in later life, such as cardiovascular diseases and cancer. Still, 33% of secondary school adolescents in the Netherlands consume sugar-sweetened beverages daily and over 26% do not consume water every day. The Dutch Healthy School program was developed to support schools in stimulating healthier lifestyles by focusing on health education, school environments, identifying students' health problems, and school policy. We examined the variation between secondary schools regarding the daily consumption of water and sugar-sweetened beverages and whether this variation can be explained by differences between schools regarding Healthy School certification, general school characteristics, and the school population.

METHODS

We performed a cross-sectional multilevel study. We used data from the national Youth Health Monitor of 2019 on secondary schools (grades 8 and 10, age range about 12 to 18 years) of seven Public Health Services and combined these with information regarding Healthy School certification and general school- and school population characteristics. Our outcomes were daily consumption of water and sugar-sweetened beverages. In total, data from 51,901 adolescents from 191 schools were analysed. We calculated the intraclass correlation to examine the variation between schools regarding our outcomes. Thereafter, we examined whether we could explain this variation by the included characteristics.

RESULTS

The school-level explained 4.53% of the variation in the consumption of water and 2.33% of the variation in the consumption of sugar-sweetened beverages. This small variation in water and sugar-sweetened consumption could not be explained by Healthy School certification, yet some general school- and school population characteristics did: the proportion of the school population with at least one parent with high educational attainment, the educational track of the adolescents, urbanicity (only for water consumption) and school type (only for sugar-sweetened beverages consumption).

CONCLUSIONS

The low percentages of explained variation indicate that school-level characteristics in general (including Healthy School certification) do not matter substantially for the daily consumption of water and sugar-sweetened beverages. Future research should examine whether school health promotion can contribute to healthier lifestyles, and if so, under which level of implementation and school conditions.

Perceived barriers to vegetable intake among urban adolescents from socioeconomically disadvantaged backgrounds: A qualitative study from the perspective of youth workers and teachers

Eating habits established during adolescence have been shown to track into adulthood. Adolescents from lower socioeconomic status groups tend to have lower intakes of vegetables as compared with their more affluent peers. However, there is limited evidence about the determinants of vegetable intake in this population group. Therefore, this study aimed to explore the barriers to vegetable intake in adolescents living in socioeconomically disadvantaged areas through the perspective of school teachers and youth workers. A total of 20 semi-structured interviews were conducted with post-primary school teachers and youth workers from disadvantaged areas in Dublin, Ireland. Thematic analysis was applied to analyze the data. Eleven themes were identified and fitted within the Socioecological Model of Health: adolescent's food preferences, lack of early exposure and familiarity with vegetables, lack of interest, knowledge and skills at the individual and family level, parenting practices around nutrition, living difficulties, peers' influence and social norms around nutrition, dual role of social media, lack of resources and support to promote healthy eating, competition between unhealthy food vs. vegetables, lack of adequate approaches & initiatives at the community and at the public policy levels, and lack of State support to promote healthy eating. Although several actions could be taken at the personal and interpersonal levels, more efforts are needed at the organizational, community and public policy levels to improve dietary choices and vegetable intake among adolescents in socioeconomically deprived areas. These findings will inform the development of tailored intervention strategies and policies for these vulnerable youths.

Satisfaction with Food: Profiles of Two-Parent Families with Adolescent Children

The objectives of this study were to distinguish family profiles based on the level of satisfaction with food-related life (SWFoL) of mothers, fathers, and adolescents, and to characterize the profiles based on the three family members' diet quality and nutritional status, family's eating habits, parental feeding practices, parent's nutritional knowledge, and sociodemographic characteristics. Questionnaires were applied to a sample of 300 two-parent families with adolescent children, aged between 10 and 17 years, in Temuco, Chile. The questionnaires used were: satisfaction with food-related life (SWFoL); adapted healthy eating index (AHEI); family eating habits questionnaire (FEHQ); and the nutritional knowledge subscale. They also answered questions about eating habits and provided data to determine BMI and sociodemographic characteristics. Four different profiles were identified with respect to SWFoL: "Families satisfied with their food" (50.6%); "Fathers and mothers moderately satisfied with their food, children satisfied" (23.2%); "Families extremely satisfied with their food" (16.6%); and "Fathers and mothers satisfied with their food, children extremely dissatisfied" (9.7%). The profiles demonstrated heterogeneity in SWFoL. Higher levels of SWFoL (mothers, fathers and adolescents) were associated with healthier eating habits. These results contribute to new studies that enable understanding of how families' healthy eating habits are part of improving quality of life.

Determinants of vegetable intake among urban socio-economically disadvantaged adolescents: a systematic review of quantitative studies

OBJECTIVE

To investigate the determinants of vegetable intake in urban socio-economically disadvantaged adolescents to inform the development of an intervention programme.

DESIGN

A narrative systematic review was carried out by searching five electronic databases from 2013 to 2020. The descriptors used for the search strategy were vegetable intake, adolescents, determinants and correlates. Inclusion criteria were including a sample of socio-economically disadvantaged adolescents aged 12-18 years, evaluation of the association between vegetable intake and determinants of intake, and conducted in urban settings of high-income countries. Thirteen studies met the inclusion criteria. Identified determinants of vegetable intake were reported according to the five levels of the socio-ecological model of health.

SETTING

Studies included in the review were conducted in four countries: USA (n 8), Australia (n 3), Ireland (n 1) and New Zealand (n 1).

PARTICIPANTS

Adolescents aged 12-18 years from socio-economically disadvantaged backgrounds living in urban settings.

RESULTS

Thirty-nine determinants were identified. Nutrition knowledge was the only determinant consistently investigated in several independent samples which was not associated with vegetable intake in socio-economically disadvantaged adolescents. For the remaining potential determinants, it was not possible to examine the consistency of evidence as there were not enough studies investigating the same determinants. Most of the studies followed a cross-sectional design and were carried out in school settings.

CONCLUSIONS

There is a need for further studies on the determinants of vegetable intake in this population preferably with longitudinal designs and beyond the school setting in different countries to guide the development of successful interventions.

Independent and combined associations between multiple lifestyle behaviours and academic grades of inner urban and peri-urban high school students: a cross-sectional study in Chongqing, China

OBJECTIVES

This study aims to assess the independent and combined associations between multiple lifestyle behaviours and academic grades of inner urban high school students (IUHSSs) and peri-urban high school students (PUHSSs).

DESIGN

A cross-sectional study was conducted.

PARTICIPANTS

There are 1481 high school students (49.9% boys) in this study, who were enrolled from one inner urban and two peri-urban schools in Chongqing, China.

OUTCOME MEASURES

Academic grades were assessed based on the students' self-reported grade ranking in the last cumulative examination.

RESULTS

In IUHSSs and PUHSSs, high frequency of sugar-sweetened beverage consumption was unlikely to obtain high academic grades (OR 0.56, 95% CI 0.32 to 0.99 and 0.63, 95% CI 0.42 to 0.96), respectively). Among IUHSSs, meeting the recommendations for weekday screen time and egg consumption (OR 1.57, 95% CI 1.06 to 2.34 and 1.60, 95% CI 1.04 to 2.47, respectively) and high frequency of fruit consumption (1.67, 95% CI 1.11 to 2.50) were significantly associated with high academic grades; meeting the recommendation for weekday sleep duration was unlikely to obtain high academic grades (0.46, 95% CI 0.21 to 0.98). Among PUHSSs, meeting the recommendations for weekend sleep duration (1.40, 95% CI 1.02 to 1.93) and eating dinner regularly (1.55, 95% CI 1.01 to 2.37) had significant associations with high academic grades. No significant associations were found between physical activity and academic grades in both IUHSSs and PUHSSs (p>0.05). Moreover, IUHSSs with 9-13 healthy lifestyle behaviours were 3.25 times more likely to achieve high academic grades than IUHSSs with 1-6 healthy lifestyle behaviours (3.25, 95% CI 1.96 to 5.40). No significant associations were found in the combined associations between multiple lifestyle behaviours and academic grades among PUHSSs (p>0.05).

CONCLUSIONS

Correlations were observed between lifestyle behaviours and academic grades among high school students, and cumulative associations between multiple healthy lifestyle behaviours and academic outcomes appear to be stronger than the independent associations. These findings are particularly applicable to IUHSSs.

Understanding Vocational Students' Motivation for Dietary and Physical Activity Behaviors

Unhealthy eating behaviors and low levels of physical activity are major problems in adolescents and young adults in vocational education. To develop effective intervention programs, more research is needed to understand how different types of motivation contribute to health behaviors. In the present study, Self-Determination Theory is used to examine how motivation contributes to dietary and physical activity behaviors in vocational students. This cross-sectional study included 809 students (mean age 17.8 ± 1.9 years) attending vocational education in the Netherlands. Linear multilevel regression analyses were used to investigate the association between types of motivation and dietary and physical activity behaviors. Amotivation was negatively associated with breakfast frequency and positively associated with diet soda consumption and high-calorie between-meal snacks. A positive association was found between autonomous motivation and water intake, breakfast frequency, fruit intake, and moderate-to-vigorous physical activity. Autonomous motivation was negatively associated with the consumption of unhealthy products. Controlled motivation was not associated with physical activity or dietary behaviors. Different types of motivation seem to explain either healthy or unhealthy dietary behaviors in vocational students. Autonomous motivation, in particular, was shown to be associated with healthy behaviors and could therefore be a valuable intervention target.

Correlates of sugar-sweetened beverages consumption among adolescents

Objective:

To identify correlates and underlying beliefs regarding the adolescents’ intention to abstain from consuming sugar-sweetened beverages (SSB) and the consumption of ≤1 daily portion of SSB.

Design:

Correlational study.

Setting:

Region of Chaudière-Appalaches in the province of Quebec, Canada.

Participants:

311 adolescents aged 13–18 years completed a self-administrated online questionnaire based on the Reasoned Action Approach. Frequency and quantity of different types of SSB within the past month were measured.

Results:

Total mean SSB intake was 882·6 ml/d (654·0 kJ/d ). Only 11·3 % abstained from SSB within the last month. Intention to abstain from SSB was explained by identification as SSB abstainers (β = 0·47), perceived norm (β = 0·32), attitude (β = 0·30), age 13–14 years (β = –0·27) and perception of the school environment (β = 0·14), which explained 66 % of the variance. Consumption of ≤1 daily portion of SSB was explained by the intention to abstain (OR = 1·55; 95 % CI 1·14, 2·11), perceived behavioural control to abstain (OR = 1·80; 95 % CI 1·29, 2·52), sex (girls v. boys: OR = 2·34; 95 % CI 1·37, 3·98) and socio-economic status (advantaged v. disadvantaged school: OR = 2·08; 95 % CI 1·21, 3·56). Underlying beliefs (i.e. more energy, decreased risk of addiction and friends’ approval) associated with intention as well as perceived barriers (e.g. access to SSB, after an activity that makes you thirsty), and facilitating factors (e.g. access to water) linked to SSB consumption were identified.

Conclusions:

The results can inform public health interventions to decrease SSB consumption and their associated health problems among adolescents.

Differences in Lifestyle Behaviours of Students between Inner Urban and Peri-urban High Schools: A Cross-Sectional Study in Chongqing, China

Background: Lifestyle behaviours of students from schools in different socioeconomic areas may be different. Few studies have investigated such topics in China. This study aimed to explore the differences in lifestyle behaviours between inner urban high school students (IUHSSs) and peri-urban high school students (PUHSSs). Methods: A cross-sectional survey based on a self-report questionnaire was administered among 1560 high school students (726 from inner urban high schools and 834 from peri-urban high schools) in Chongqing, China. Physical activity, sleep time, screen time and dietary behaviours were assessed according to a series of recommendations of Chinese guidelines. Results: No significant difference was found in meeting the recommendation for daily physical activity between IUHSSs and PUHSSs (7.6% vs. 6.8%, p > 0.05). PUHSSs were more likely to meet the recommendations of weekdays’ sleep time (14.9% vs. 5.4%, p < 0.001), weekdays’ and weekends’ screen time (85.4% vs. 76.7%, p < 0.001; 21.1% vs. 14.3%, p < 0.001), and had higher proportion of high-score group of dietary behaviours (58.6% vs. 36.4%, p < 0.001) than those of IUHSSs. IUHSSs were more likely to meet the recommendation of weekends’ sleep time (75.6% vs. 67.9%, p < 0.001) than that of PUHSSs. Conclusions: A low proportion met the recommendations of physical activity, weekdays’ sleep time and weekends’ screen time among high school students in Chongqing, China. Lifestyle behaviours may differ between inner urban and peri-urban high school students. Additional support or targeted health education should be provided by high schools to improve the lifestyle behaviours of students, especially in inner urban districts.

Socioeconomic status and physical fitness in youth: Findings from the NHANES National Youth Fitness Survey

This study examined the associations between socioeconomic status (SES) and musculoskeletal (MSF) and cardiorespiratory fitness (CRF) in youth.  The sample consisted of boys and girls between 3-15 years.  SES was categorized utilizing family-income-to-poverty ratio (FIPR).  All analyses were standardized for age and sex.  For each test of physical fitness, SES was used to estimate mean fitness test percentile and 95% confidence intervals, controlling for race/ethnicity and physical activity.  Odds ratios were calculated for the likelihood of having low fitness by SES category.  In general, the high SES group had a better composite MSF, body composition, and CRF profiles than low and moderate SES groups.  Statistically significant differences were identified for relative grip strength, plank, body mass index, and cardiovascular endurance time (all p < 0.05).  Additionally, the odds of low/poor MSF fitness were 1.7 and 1.6 times higher in the low and moderate SES groups (respectively) compared to the children from high SES families.  The moderate SES group had an odds of poor CRF 1.6 times higher than the high SES group as well.  Children and adolescents from high SES families tend to have higher mean fitness and were less likely to have low/poor fitness.