Trends of Healthy Lifestyles Among Adolescents: An Analysis of More Than Half a Million Participants From 32 Countries Between 2006 and 2014.

The purpose of this study was to provide data regarding the prevalence and trends of adolescents' healthy lifestyles from 32 countries between 2006 and 2014 by sex and age interval. The data used in the present study were derived from the Health Behavior in School-aged Children (HBSC) 2006, 2010, and 2014 international database. Healthy lifestyle was assessed using the combination of daily physical activity, daily fruit and vegetable consumption, <2 h daily on screen-based behaviors, abstinence from alcohol, and abstinence from tobacco products. Healthy lifestyle measures were based on self-report. The final sample comprised 519,371 adolescents (aged between 10 and 16 years old). The prevalence of healthy lifestyle behaviors increased between 2006 and 2014. The healthy lifestyle score worsened with advancing age for boys and girls. Comparing countries, for boys, the highest values were observed in adolescents from Ireland (5.2%, 95% CI: 3.9, 6.4), and for girls, the highest values were observed in adolescents from Iceland (4.2%, 95% CI: 3.6, 4.7). The present study showed a slight trend to an improved healthy lifestyle among adolescents, although much more has to be done. A joint effort from multiple areas of knowledge must be made to improve adolescent health policies, since lifestyles in adolescence play an important role for the development of vulnerability and health in later life.

Cultural adaptation of the health behaviour protocol in school-aged children for the brazilian reality / Adaptação cultural do protocolo health behaviour in school-aged children para a realidade brasileira / Adaptación cultural del health behaviour protocol in school-aged children para la realidad brasileña

Adolescence is a period of intense transformations, and these may be inherent or present risks to development. Adolescent health directly influences on individual and society future trajectories, assuring the need for research about this life span stage. The Health Behaviour in School-aged Children task force, together with World Health Organization (HBSC-WHO), has been conducting health surveys for more than 30 years with its protocol, with approximately 40 countries in North America and Europe. This work aimed to present the translation and cultural adaptation process of the HBSC instrument for the Brazilian reality. This is the first study to carry out the adaptation of this instrument in Brazil. The process used the translation of judges, a committee, evaluation in the target public, and pilot study. It was concluded by the satisfactory adaptation of the instrument to the Brazilian reality, being configured as Questionnaire HBSC Brazil.

A adolescência é uma fase de intensas transformações, podendo ser propícia ou apresentar riscos ao desenvolvimento. A saúde adolescente influencia diretamente em trajetórias futuras individuais e da sociedade como um todo, confirmando a necessidade de investigações acerca desse período do ciclo vital. A força-tarefa Health Behaviour in School-aged Children, com a World Health Organization (HBSC-WHO), vem realizando levantamentos da saúde há mais de 30 anos com um protocolo próprio, contando com aproximadamente 40 países da América do Norte e Europa. O objetivo deste trabalho foi apresentar o processo de tradução e adaptação cultural do instrumento HBSC para a realidade brasileira. Este é o primeiro estudo a realizar a adaptação desse instrumento no Brasil. O processo utilizou a tradução de juízes, um comitê da área, a avaliação em público-alvo e o estudo-piloto. Concluiu-se pela adaptação satisfatória do instrumento para a realidade brasileira, configurando-se Questionário HBSC Brasil.

La adolescencia es una fase de intensas transformaciones, pudiendo ser positiva o presentar riesgos al desarrollo. La salud adolescente influye directamente en trayectorias futuras individuales y de la sociedad, confirmando la necesidad de investigaciones acerca de este período del ciclo vital. La fuerza de trabajo Health Behaviour in School-aged Children, con la World Health Organization (HBSC-WHO), ha realizado levantamientos de salud hace más de 30 años con un protocolo propio, contando con aproximadamente 40 países de América del Norte y Europa. El objetivo de este trabajo fue presentar el proceso de traducción y adaptación cultural del instrumento HBSC para la realidad brasileña. Este es el primer estudio a realizar la adaptación de este instrumento en Brasil. El proceso utilizó la traducción de jueces, un comité del área, evaluación en público objetivo y estudio piloto. Se concluyó por la adaptación satisfactoria del instrumento a la realidad brasileña, configurándose Cuestionario HBSC Brasil.

Gendered trends in early and very early sex and condom use in 20 European countries from 2002 to 2010.

BACKGROUND: Sexual activity is often initiated during the adolescent period, and previous research suggests that the age of first sexual intercourse and condom use are crucial determinants of later sexual health. This study examined trends in adolescent sexual behaviours from 2002 to 2010 in 20 countries across four geographical regions of Europe. METHODS: Data were collected by self-report questionnaires from 15-year-olds in classrooms during 2002, 2006 and 2010. Linear time trends were determined through logistic regression models, stratified for gender. RESULTS: No linear trend over time was documented for most countries for sexual intercourse at the age of 13 or younger. Increased initiation among girls in Eastern Europe and decreased very early initiation among girls in Northern Europe emerged, along with a general increase in condom use in boys and most notably in girls. CONCLUSION: Overall prevalence of early and very early sexual intercourse initiation was quite stable in Europe between 2002 and 2010, while condom use increased. More detailed research and policy attention to the antecedents of non-condom use among young people is warranted; and further study of the relationships between age of sexual initiation and condom or pill use would be particularly valuable.

Sleep deprivation in adolescents: correlations with health complaints and health-related quality of life.

OBJECTIVES: The present study aimed to evaluate the influences of sleep duration, sleep deprivation, and weekend variability of sleep upon other adolescents' features, namely those related to health and health-related quality of life. METHODS: The Health Behaviour in School-Aged Children (HBSC) survey is based on a self-completed questionnaire. The participants in the present study were 3476 students (53.8% were girls) in the 8th and 10th grades at school; the mean age was 14.9 years (range 12.5-19.0). Subjective sleep duration during the weeknights and weekends was collected; sleep deprivation (SD) was considered whenever the difference was greater than 3 h. Health complaint frequency and health-related quality of life (with the Kidscreen 10) were collected. RESULTS: Sleep deprivation was present in 18.9% of the students. It was negatively correlated with sleep duration on weeknights. There were no gender differences, but SD increased with age and grade. Higher school grades were mainly associated with fatigue. A considerable number of adolescents had sleep problems (37.2%); 25.5% had difficulties in sleep initiation, which was more prevalent in adolescents with SD. The sleep duration on weeknights was decreased in the SD group. The average health-related quality of life was reduced in adolescents with SD. The frequency of health complaint was higher is adolescents with SD. Girls had significantly more health complaints than boys, with special focus on headaches. CONCLUSIONS: Sleep deprivation is associated with the perception of health-related quality of life and perceived physical and mental health.

Psychosocial factors of different health behaviour patterns in adolescents: association with overweight and weight control behaviours.

Physical activity, nutrition, and sedentary behaviour combine to influence the risk of overweight among adolescents. This paper aims to identify psychosocial factors of different health behaviour patterns in adolescents and its association with overweight and weight control behaviours. The 3069 adolescents of both genders (average of 14.8 years old) from the 2010 Portuguese survey of Health Behaviour School-Aged Children (HBSC) answered the 2010 HBSC self-reported questionnaire. It used the cluster k-means (nonhierarchy method), qui-square, one-way ANOVA, and logistic regression. Three clusters with different behavioural patterns (physical activity, sedentary, and eating) composed the results obtained. The sedentary group (34%) had lower self-regulation, body satisfaction, health and wellness, family and classmates relationships, communication with the father than the other two groups. The active gamers (25%) had a smaller BMI but used more unhealthy weight control strategies than the other two groups. The healthy group (41%) was more motivated and more satisfied with school but was not different than the active gamers in most psychosocial variables. Differences were found between clusters for weight control behaviours and psychosocial variables. Different strategies for different patterns were necessary in order to promote obesity prevention and, simultaneously, target healthy lifestyle and wellbeing in adolescents.

Are adolescent weight-related problems and general well-being essentially an issue of age, gender or rather a pubertal timing issue?

OBJECTIVE: To compare the characteristics of a set of weight-related and well-being variables among adolescents according to gender and age. It was hypothesised that time of puberty, not age in itself, might be the turning point for gender dissimilarities. METHODS: Data were drawn from the Portuguese 2006 HBSC/WHO database and were disaggregated by gender and age group. Groups were compared for dieting, body image, health perception and happiness variables on the bivariate level using cross-tabulations. Separate analysis of the dependent variables was further conducted for 11-year-olds comparing males with pre- and post-menarche females. RESULTS: Dieting and a negative body image were consistently more prevalent among girls and increased with age. At 11 years significantly more post-menarche girls were dieting and dissatisfied with their body image than boys and their pre-menarche counterparts. A poor self-rated health and the perception of unhappiness tended to be more common among older adolescents and among girls. CONCLUSIONS: Pubertal timing, and not age in itself, appears as the turning point for gender dissimilarities. Both gender- and age-specific differences as well as pubertal timing have to be taken into account by any physician when assessing an adolescent in order to be able to adapt the intervention.

Exercise autonomous motivation predicts 3-yr weight loss in women.

PURPOSE: This study evaluated exercise-related predictors of successful long-term weight control in women by analyzing the extent to which sustained exercise participation and self-determination theory (SDT)-based exercise motivation variables mediated the impact of a behavioral weight control intervention on 3-yr weight change. METHODS: Longitudinal randomized controlled trial consisting of a 1-yr SDT-based intervention and a 2-yr follow-up with 221 female participants (means ± SD: age = 37.6 ± 7 yr, body mass index = 31.6 ± 4.1 kg·m(-2)). The tested model incorporated experimentally manipulated perceived need support, motivational regulations, and 2-yr exercise adherence as mediators of the intervention's impact on 3-yr weight change. Paths were tested using partial least squares analysis. Where there were significant intervening paths, tests of mediation were conducted. RESULTS: Treatment had significant effects on 1- and 2-yr autonomous regulations, 2-yr physical activity, and 3-yr weight change, fully mediated by the tested paths (effect ratio = 0.10-0.61). Moderate and vigorous exercise at 2 yr had a significant effect (P < 0.001) on weight loss success at 3 yr and partially mediated the effect of treatment on weight change. The 2-yr autonomous regulation effects on follow-up weight change were only partially mediated by physical activity (effect ratio = 0.42). CONCLUSIONS: This application of SDT to physical activity and weight management showed that not all types of motivation predict long-term behavioral outcomes and that sustained moderate and vigorous exercise mediated long-term weight change. It provides strong evidence for a link between experimentally increased autonomous motivation and exercise and long-term weight loss maintenance. Results highlight the importance of interventions targeting the internalization of exercise behavioral regulation and making exercise and physical activity positive and meaningful experiences rather than simply focusing on immediate behavior change in overweight/obese women.

Neighborhood and physical activities of Portuguese adolescents.

BACKGROUND: This study examines associations between perceptions of neighbourhood environment and physical activity and sports within Portuguese adolescents. METHODS: The sample consisted of 4,877 individuals of both genders, with an average age of 14 years. The instrument used was the Health Behavior School-aged Children questionnaire. RESULTS: Perceptions of the neighbourhood being unsafe for children to play and having no place to spend leisure time were associated with lower levels of exercise among adolescents. The perceptions of the neighbourhood being unsafe for children to play (OR = 1.3, p < .005) and the fact of not having a place to spend leisure time (OR = 1.3, p < .005) p < .005) were associated with lower levels of exercise among adolescents. The perception of these variables is associated to a lower probability of exercising. The neighbourhood characteristics are more important to the practice of outdoor sports than of indoor sports. CONCLUSION: The perceptions of the neighbourhood may influence adolescent's physical activity and sports, in different ways.

Using self-determination theory to promote physical activity and weight control: a randomized controlled trial in women.

Behavior change interventions are effective to the extent that they affect appropriately-measured outcomes, especially in experimental controlled trials. The primary goal of this study was to analyze the impact of a 1-year weight management intervention based on self-determination theory (SDT) on theory-based psychosocial mediators, physical activity/exercise, and body weight and composition. Participants were 239 women (37.6 +/- 7.1 years; 31.5 +/- 4.1 kg/m(2)) who received either an intervention focused on promoting autonomous forms of exercise regulation and intrinsic motivation, or a general health education program (controls). At 12 months, the intervention group showed increased weight loss (-7.29%,) and higher levels of physical activity/exercise (+138 +/- 26 min/day of moderate plus vigorous exercise; +2,049 +/- 571 steps/day), compared to controls (P < 0.001). Main intervention targets such as more autonomous self-regulation (for treatment and for exercise) and a more autonomous perceived treatment climate revealed large effect sizes (between 0.80 and .96), favoring intervention (P < 0.001). Results suggest that interventions grounded in SDT can be successfully implemented in the context of weight management, enhancing the internalization of more autonomous forms of behavioral regulation, and facilitating exercise adherence, while producing clinically-significant weight reduction, when compared to a control condition. Findings are fully consistent with previous studies conducted within this theoretical framework in other areas of health behavior change.

Are overweight adolescents at higher risk of engaging in unhealthy weight-control behaviours?

AIM: To examine correlates of unhealthy weight-control behaviours (UNWCB), and to explore possible associated variables. METHODS: Sample included 3762, 8th and 10th grade public school Portuguese students who participated in the 2002 Health Behaviour in School-Aged Children (HBSC)/World Health Organization (WHO) survey of adolescent health. Factor analysis was used, and two scales were identified as 'healthy weight-control behaviours' (HWCB) and 'UNWCB' through Kaiser criteria analysis. Frequency scores were developed and used in analysis of variance (ANOVAs) test as dependent variables, according to gender and age. Pearson correlations and post-hoc analysis were performed to identify potential associations. RESULTS: UNWCB were significantly higher among those who were dieting or not dieting, but considering they should, and were significantly and progressively increasing from those perceiving themselves as thin, to those perceiving themselves as being the right size and those perceiving themselves as fat. Overweight reported more frequently than non-overweight, both HWCB and UNWCB. Finally, there were significant differences concerning alcohol use, with UNWCB increasing progressively from reporting 'drinking rarely or never' to 'drinking every week' and 'everyday'. CONCLUSION: Because UNWCB are associated with both medical and psychological health risks, routine screening is warranted. Special attention needs to be directed towards youth at greatest risk for disordered eating, including overweight youth.

Are overweight and obese adolescents different from their peers?

OBJECTIVE: To identify psychosocial and lifestyle indicators including alcohol consumption, that may distinguish overweight and obese adolescents from their peers, and align them with other adolescents with chronic conditions. METHODS: The sample included 6 131 6th, 8th, and 10th grade public school Portuguese students, aged 11-16 years, who participated in the Health Behavior in School-Aged Children (HBSC)/WHO survey of adolescent health. Body mass index (BMI) was based on self reported weight and height. Separate analyses of psychosocial and behavioral variables were conducted by gender, age group, and BMI, using Chi square, and ANOVA. RESULTS: Obese and overweight teens when compared with non-overweight teens, were more likely to report a negative attitude towards their appearance; to believe that others made negative comments about them; had a lower level of life satisfaction; had more difficulty in making new friends, and were more likely to describe themselves as unhappy. Moreover, obese teens were significantly more likely than their non-obese peers to describe themselves as having health problems, to report drinking alcohol daily, as well as having been drunk more than 10 times. CONCLUSIONS: The present study provides further evidence regarding the association between overweight and obesity in adolescence, and body image dissatisfaction, poorer self-assessed health status, potential social isolation, decreased life satisfaction, and problematic alcohol consumption patterns. Overweight and obese adolescents should, where possible, be reached with appropriate interventions addressing the broad spectrum of their psychological needs, enhancing their skill development for behavioral change, and providing support for dealing with potentially harmful behaviors.

A randomized controlled trial to evaluate self-determination theory for exercise adherence and weight control: rationale and intervention description.

BACKGROUND: Research on the motivational model proposed by Self-Determination Theory (SDT) provides theoretically sound insights into reasons why people adopt and maintain exercise and other health behaviors, and allows for a meaningful analysis of the motivational processes involved in behavioral self-regulation. Although obesity is notoriously difficult to reverse and its recidivism is high, adopting and maintaining a physically active lifestyle is arguably the most effective strategy to counteract it in the long-term. The purposes of this study are twofold: i) to describe a 3-year randomized controlled trial (RCT) aimed at testing a novel obesity treatment program based on SDT, and ii) to present the rationale behind SDT's utility in facilitating and explaining health behavior change, especially physical activity/exercise, during obesity treatment. METHODS: Study design, recruitment, inclusion criteria, measurements, and a detailed description of the intervention (general format, goals for the participants, intervention curriculum, and main SDT strategies) are presented. The intervention consists of a 1-year group behavioral program for overweight and moderately obese women, aged 25 to 50 (and pre-menopausal), recruited from the community at large through media advertisement. Participants in the intervention group meet weekly or bi-weekly with a multidisciplinary intervention team (30 2 h sessions in total), and go through a program covering most topics considered critical for successful weight control. These topics and especially their delivery were adapted to comply with SDT and Motivational Interviewing guidelines. Comparison group receive a general health education curriculum. After the program, all subjects are follow-up for a period of 2 years. DISCUSSION: Results from this RCT will contribute to a better understanding of how motivational characteristics, particularly those related to physical activity/exercise behavioral self-regulation, influence treatment success, while exploring the utility of Self-Determination Theory for promoting health behavior change in the context of obesity. TRIAL REGISTRATION: Clinical Trials Gov. Identifier NCT00513084.

AIDS-related stigma and attitudes towards AIDS-infected people among adolescents.

UNLABELLED: This research examined the co-occurrence of accurate and inaccurate knowledge about HIV transmission among adolescents. Analyses were also conducted to examine the way in which variables related to demographic factors, personal characteristics, parent and peer relationships, and school involvement are associated with attitudes towards HIV/AIDS-infected people. Social and psychological processes that contribute to AIDS-related stigma are also described. METHODS: Data were collected from the Portuguese sample of the 'Health Behaviour in School-Aged Children - 2002 - a collaborative WHO study'. The study provided data representative of 6137 Portuguese adolescents at national level. Based on these results, we conducted 14 focus groups discussions. RESULTS: Adolescents presented high levels of knowledge about HIV transmission. However, the proportion of young people who hold misperceptions is also high. A multiple regression analysis identified several associations with attitudes towards HIV-infected persons. The focus groups showed that adolescents believe that people with AIDS experienced discrimination and social exclusion. Adolescents' opinions for HIV-infected persons were mostly positive and tolerant, although some adolescents showed an ambivalent attitude and undefined fears. CONCLUSION: These findings have significant implications to implement and design comprehensive interventions with impact in adolescents' attitudes towards people with HIV/AIDS.

Preventing HIV transmission in adolescents: an analysis of the Portuguese data from the Health Behaviour School-aged Children study and focus groups.

BACKGROUND: There is recognition of the need to examine psychosocial and ecological determinants contributing to both risk and protective factors related to adolescents' sexual behaviour and HIV/AIDS. METHODS: The study utilized mixed quantitative and qualitative methods. Data were collected from the Portuguese sample of the Health Behaviour in School-aged Children (HBSC) 2002. Based on these results, 14 focus group discussions were conducted. RESULTS: A substantial minority of young people continue to engage in high-risk practices. Thus, female gender, older age, reporting easy to talk with father, not getting drunk and not getting involved in fights are significantly associated with protected sexual behaviour (using condom during last sexual intercourse). According to these results, being female and a comprehensive grade student are both related to a significantly more positive attitude towards infected people. It was concluded that these adolescents view sexual behaviour, sexual partners and condom use as elements within a complex script that governs heterosexual interactions. Several themes related to condom used emerged. Despite HIV/AIDS knowledge, young people underestimate their own risk of becoming infected with HIV. The majority of adolescents believe that HIV-infected people experience discrimination and social exclusion. Adolescents' opinions of HIV-infected people were mostly positive. Although most participants knew that HIV cannot be transmitted through social contact, undefined fears concerning the infection exist. CONCLUSIONS: These findings have important implications for the implementation of a comprehensive programme on HIV/AIDS education in secondary schools.