Clustering of health-related behaviors, health outcomes and demographics in Dutch adolescents: a cross-sectional study.

BACKGROUND: Recent studies show several health-related behaviors to cluster in adolescents. This has important implications for public health. Interrelated behaviors have been shown to be most effectively targeted by multimodal interventions addressing wider-ranging improvements in lifestyle instead of via separate interventions targeting individual behaviors. However, few previous studies have taken into account a broad, multi-disciplinary range of health-related behaviors and connected these behavioral patterns to health-related outcomes. This paper presents an analysis of the clustering of a broad range of health-related behaviors with relevant demographic factors and several health-related outcomes in adolescents. METHODS: Self-report questionnaire data were collected from a sample of 2,690 Dutch high school adolescents. Behavioral patterns were deducted via Principal Components Analysis. Subsequently a Two-Step Cluster Analysis was used to identify groups of adolescents with similar behavioral patterns and health-related outcomes. RESULTS: Four distinct behavioral patterns describe the analyzed individual behaviors: 1- risk-prone behavior, 2- bully behavior, 3- problematic screen time use, and 4- sedentary behavior. Subsequent cluster analysis identified four clusters of adolescents. Multi-problem behavior was associated with problematic physical and psychosocial health outcomes, as opposed to those exerting relatively few unhealthy behaviors. These associations were relatively independent of demographics such as ethnicity, gender and socio-economic status. CONCLUSIONS: The results show that health-related behaviors tend to cluster, indicating that specific behavioral patterns underlie individual health behaviors. In addition, specific patterns of health-related behaviors were associated with specific health outcomes and demographic factors. In general, unhealthy behavior on account of multiple health-related behaviors was associated with both poor psychosocial and physical health. These findings have significant meaning for future public health programs, which should be more tailored with use of such knowledge on behavioral clustering via e.g. Transfer Learning.

Patterns of pain variation related to myogenous temporomandibular disorders.

OBJECTIVES: Myogenous temporomandibular disorders are characterized by jaw muscle pain. The aims were: 1) to characterize this pain generally in terms of intensity, frequency, duration, and behavior across a period of 2 weeks; 2) to identify main intraday pain patterns and to examine whether subgroups of patients in this respect differed in clinical, demographic, pain and sleep variables, psychosocial factors, and use of medication; and 3) to investigate some possible interday trends of pain intensity at a group level. METHOD: One hundred thirty-three patients with myogenous temporomandibular disorders completed a 2-week diary, rating pain intensity (100 mm Visual Analog Scale [VAS]), duration, behavior (verbal 6-point scale), and medication use on 4 times of the day. Furthermore, questionnaires were completed to score pain period before seeking treatment, spread of pain, and demographic, psychosocial, and sleep variables. RESULTS: In the diary, pain intensity, frequency, daily pain duration, and the score of pain behavior were on average 29.1 mm, 69% of the scoring times, 5.5 hours, and 1.8 points (approaching "pain present, but I can ignore it at times"), respectively. Pain intensity was, on average, maximal late in the day (before dinner or bedtime) for the majority of patients (79%) and early in the day (before breakfast or lunchtime) for the minority (21%). The larger subgroup had a significantly higher daily pain intensity, more frequently a widespread pain and problems with falling asleep at bedtime, agreed more about the role of a physician as an external health locus of control, and had a more distancing coping style. Both subgroups were similar for other variables, most notably in the level of state anxiety and depressive mood, and in a sparse use (7.8% of all possible times) of over-the-counter medication. Daily mean VAS scores, averaged across patients, were approximately constant for the various diary days. Both the daily mean and maximal VAS score were not related to a specific day of the week. CONCLUSIONS: Two main daily pain patterns occur in patients with myogenous temporomandibular disorders (79%: maximal pain late in the day; 21%: early in the day), which might be related to differences in processes that influence pain sensitivity and patterns of jaw muscle activation. The interday similarities in pain level suggest that a sustained influence of counseling after the intake or an influence of a common behavioral pattern with a cycle duration of a week are not involved.