Adolescents' healthy lifestyle

Marques, Adilson; Loureiro, Nuno; Avelar-Rosa, Bruno; Naia, Ana; Matos, Margarida Gaspar de

doi:10.1016/j.jped.2018.09.002

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Original articles • J. Pediatr. (Rio J.) 96 (2) • Mar-Apr 2020 • https://doi.org/10.1016/j.jped.2018.09.002 copy

Adolescents' healthy lifestyle^☆ ☆ Please cite this article as: Marques A, Loureiro N, Avelar-Rosa B, Naia A, Matos MG. Adolescents' healthy lifestyle. J Pediatr (Rio J). 2020;96:217-24.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

Using a wide and representative sample of adolescents from 37 countries, this study aimed to analyze how age changes adolescents' healthy lifestyle.

Methods:

The study included 148,839 adolescents who participated in the Health Behavior in School-aged Children 2010 survey. A composite score of a healthy lifestyle was created 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.

Results:

4.7% of boys and 4.4% of girls aged 11 years, 3% of boys and 2% of girls aged 13 years, and 1.5% of boys and 0.8% of girls aged 15 scored perfectly on the healthy lifestyle score. As age increased, the prevalence of adolescents with a healthy lifestyle decreased. In 37 countries and regions, the prevalence of healthy behaviors decreased linearly between early adolescence and the age of 15 years.

Conclusions:

In general, adolescents do not have a healthy lifestyle. Results from this study highlight that there is still much work to be done in promoting healthy lifestyles and to raise awareness among adolescents of the potential risk to their health status.

KEYWORDS
Health; Health behavior in school-aged children; Physical activity; Sedentary behavior; Alcohol drink; Tobacco

	%
Sex
Boys	48.0
Girls	52.0
Age
11 years	29.5
13 years	35.0
15 years	35.5
Lives with mother
No	5.9
Yes	94.1
Lives with father
No	23.0
Yes	77.0
Has siblings
No	16.8
1-2 siblings	66.8
≥3 siblings	16.4
FAS
Low	5.0
Medium	34.7
High	60.3

	11 years (n = 21,138) % (95% CI)	13 years (n = 24,816) % (95% CI)	15 years (n = 25,461) % (95% CI)	p ^b b Tested by chi-squared test for trend.	Difference between 15 and 11 years (95% CI)
Boys
Healthy lifestyle behavior
Physical activity every day	26.6 (25.4, 27.7)	23.9 (22.8, 25.0)	18.9 (17.8, 20.0)	<0.001	-7.7 (-8.4, -6.9)
Screen time <2 h/day	24.7 (23.5, 25.9)	16.1 (15.0, 17.2)	12.8 (11.7, 14.0)	<0.001	-11.9 (-12.6, -11.2)
Eats fruits/vegetable daily	22.5 (21.3, 23.7)	19.1 (18.0, 20.2)	16.2 (15.1, 17.3)	<0.001	-6.3 (-7.0, -5.6)
Does not consume alcohol	89.1 (88.6, 89.5)	76.9 (76.3, 77.5)	55.3 (54.4, 56.1)	<0.001	-33.8 (-34.6, -33.1)
Does not smoke	97.3 (97.1, 97.5)	91.8 (91.4, 92.2)	76.7 (76.1, 77.3)	<0.001	-20.6 (-21.2, -20.1)
Number of behaviors reported
None	0.4 (-1.0, 1.7)	1.7 (0.5, 3.0)	6.4 (5.2, 7.6)	<0.001	6.0 (5.7, 6.3)
1 behavior	3.9 (2.6, 5.2)	8.9 (7.7, 10.1)	19.6 (18.5, 20.7)	<0.001	15.7 (15.2, 16.3)
2 behaviors	27.9 (26.7, 29.0)	30.9 (29.9, 32.0)	33.4 (32.4, 34.4)	<0.001	5.6 (4.7, 6.4)
3 behaviors	42.9 (41.9, 43.9)	39.9 (38.9, 40.9)	29.6 (28.5, 30.6)	<0.001	-13.3 (-14.2, -12.5)
4 behaviors	20.2 (19.0, 21.4)	15.6 (14.4, 16.7)	9.5 (8.3, 10.7)	<0.001	-10.7 (-11.3, -10.0)
5 behaviors^a a Adolescents with a healthy lifestyle.	4.7 (3.4, 6.0)	3.0 (1.8, 4.2)	1.5 (0.3, 2.7)	<0.001	-3.3 (-3.6, -2.9)
	Mean (95% CI)	Mean (95% CI)	Mean (95% CI)	p ^c c Tested by ANCOVA for linear contrast analysis. Analyses were adjusted for living with mother, living with father, having siblings, and family affluence scale.	Mean (95% CI)
All behaviors
Mean of behavior reported	2.6 (2.6, 2.6)	2.3 (2.3, 2.3)	1.8 (1.8, 1.8)	<0.001	-0.8 (-0.8, -0.8)
	11 years (n = 22,788) % (95% CI)	13 years (n = 27,207) % (95% CI)	15 years (n = 27,429) % (95% CI)	p ^b b Tested by chi-squared test for trend.	Difference between 15 and 11 years (95% CI)
Girls
Healthy lifestyle behavior
Physical activity every day	18.2 (17.0, 19.4)	12.9 (11.8, 14.0)	9.4 (8.3, 10.6)	<0.001	-8.8 (-9.4, -8.2)
Screen time <2 h/day	33.3 (32.3, 34.4)	20.6 (19.5, 21.6)	18.7 (17.6, 19.8)	<0.001	-14.6 (-15.4, -13.9)
Eats fruits/vegetable daily	29.3 (28.2, 30.4)	23.8 (22.8, 24.9)	22.6 (21.5, 23.6)	<0.001	-6.7 (-7.5, -5.9)
Does not consume alcohol	93.0 (92.6, 93.3)	76.8 (76.2, 77.4)	49.5 (48.7, 50.3)	<0.001	-43.5 (-44.1, -42.8)
Does not smoke	98.8 (98.7, 99.0)	92.1 (91.8, 92.4)	77.3 (76.7, 77.8)	<0.001	-21.6 (-22.1, -21.0)
Number of behaviors reported
None	0.2 (-1.1, 1.5)	2.4 (1.2, 3.6)	8.7 (7.6, 9.9)	<0.001	8.6 (8.2, 8.9)
1 behavior	2.8 (1.5, 4.0)	10.3 (9.2, 11.5)	23.1 (22.1, 24.1)	<0.001	20.4 (19.8, 20.9)
2 behaviors	29.0 (27.9, 30.1)	34.6 (33.6, 35.5)	34.0 (33.0, 35.0)	<0.001	5.0 (4.2, 5.8)
3 behaviors	44.1 (43.1, 45.1)	37.5 (36.5, 38.4)	26.1 (25.0, 27.1)	<0.001	-18.0 (-18.9, -17.2)
4 behaviors	19.6 (18.4, 20.8)	13.2 (12.1, 14.4)	7.2 (6.1, 8.4)	<0.001	-12.4 (-13.0, -11.8)
5 behaviors	4.4 (3.2, 5.7)	2.0 (0.8, 3.2)	0.8 (-0.3, 2.0)	<0.001	-1.5 (-1.7, -1.3)
	Mean (95% CI)	Mean (95% CI)	Mean (95% CI)	p ^c c Tested by ANCOVA for linear contrast analysis. Analyses were adjusted for living with mother, living with father, having siblings, and family affluence scale.	Mean (95% CI)
All behaviors
Mean of behavior reported	2.7 (2.7, 2.7)	2.3 (2.3, 2.3)	1.8 (1.8, 1.8)	<0.001	-0.9 (-0.9, -0.9)

Countries	Total	Boys Mean (95% CI)			Girls Mean (95% CI)
Countries	Total	11 years	13 years	15 years	11 years	13 years	15 years
Ireland	3,222	3.0 (2.9, 3.1)	2.6 (2.6, 2.7)	2.2 (2.2, 2.3)	3.0 (2.9, 3.1)	2.6 (2.5, 2.7)	2.0 (1.9, 2.1)
Macedonia	3,073	2.9 (2.8, 2.9)	2.5 (2.5, 2.6)	2.2 (2.1, 2.2)	3.0 (2.9, 3.1)	2.5 (2.5, 2.6)	2.3 (2.3, 2.4)
Switzerland	5,435	3.0 (3.0, 3.1)	2.6 (2.5, 2.6)	1.9 (1.8, 2.0)	3.2 (3.1, 3.2)	2.7 (2.6, 2.7)	2.1 (2.0, 2.2)
United States	4,951	2.8 (2.8, 2.9)	2.6 (2.6, 2.7)	2.3 (2.2, 2.4)	2.9 (2.9, 3.0)	2.5 (2.5, 2.6)	2.2 (2.1, 2.2)
Luxembourg	3,029	3.0 (2.9, 3.1)	2.6 (2.5, 2.7)	2.0 (1.9, 2.1)	2.9 (2.8, 3.0)	2.6 (2.5, 2.6)	2.1 (2.0, 2.2)
Belgium^a a French.	3,266	2.9 (2.8, 3.0)	2.4 (2.3, 2.5)	2.0 (1.9, 2.1)	2.8 (2.8, 2.9)	2.4 (2.4, 2.5)	1.9 (1.8, 2.0)
Israel	3,026	2.7 (2.6, 2.7)	2.4 (2.3, 2.5)	2.0 (1.9, 2.1)	2.7 (2.6, 2.7)	2.5 (2.4, 2.5)	2.3 (2.2, 2.3)
Iceland	9,301	2.7 (2.6, 2.7)	2.3 (2.3, 2.4)	2.0 (1.9, 2.0)	2.9 (2.8, 2.9)	2.5 (2.5, 2.5)	2.0 (2.0, 2.1)
Canada	11,672	2.6 (2.6, 2.7)	2.4 (2.4, 2.4)	2.0 (2.0, 2.1)	2.8 (2.8, 2.9)	2.3 (2.2, 2.3)	1.9 (1.9, 1.9)
France	4,771	2.7 (2.6, 2.8)	2.3 (2.3, 2.4)	1.9 (1.8, 1.9)	2.8 (2.7, 2.8)	2.4 (2.3, 2.4)	2.0 (1.9, 2.0)
Austria	3,778	2.9 (2.8, 3.0)	2.5 (2.4, 2.5)	1.6 (1.5, 1.6)	3.1 (3.0, 3.1)	2.4 (2.3, 2.5)	1.5 (1.4, 1.6)
Spain	3,919	2.8 (2.7, 2.9)	2.3 (2.2, 2.3)	1.9 (1.8, 1.9)	2.8 (2.7, 2.9)	2.3 (2.2, 2.3)	1.7 (1.6, 1.8)
Germany	3,871	2.8 (2.7, 2.8)	2.3 (2.2, 2.3)	1.6 (1.5, 1.7)	2.9 (2.8, 3.0)	2.4 (2.3, 2.5)	1.7 (1.6, 1.8)
Romania	3,678	2.6 (2.5, 2.7)	2.2 (2.1, 2.3)	1.7 (1.7, 1.8)	2.7 (2.6, 2.8)	2.3 (2.3, 2.4)	2.0 (1.9, 2.0)
Slovakia	3,813	2.5 (2.5, 2.6)	2.3 (2.2, 2.3)	1.9 (1.8, 1.9)	2.6 (2.6, 2.7)	2.2 (2.1, 2.3)	1.9 (1.8, 1.9)
Belgium^b b Flemish.	3,257	2.6 (2.6, 2.7)	2.3 (2.2, 2.4)	1.6 (1.6, 1.7)	2.7 (2.6, 2.8)	2.4 (2.3, 2.5)	1.7 (1.6, 1.8)
Portugal	3,349	2.6 (2.5, 2.6)	2.3 (2.2, 2.3)	1.7 (1.7, 1.8)	2.6 (2.6, 2.7)	2.2 (2.1, 2.2)	1.9 (1.8, 2.0)
England	2,243	2.6 (2.5, 2.7)	2.3 (2.2, 2.4)	1.9 (1.8, 2.0)	2.7 (2.6, 2.8)	2.2 (2.1, 2.2)	1.7 (1.6, 1.8)
Poland	3,229	2.5 (2.4, 2.6)	2.1 (2.1, 2.2)	1.9 (1.8, 2.0)	2.6 (2.6, 2.7)	2.2 (2.2, 2.3)	1.8 (1.8, 1.9)
Ukraine	3,858	2.5 (2.5, 2.6)	2.2 (2.1, 2.3)	1.8 (1.7, 1.9)	2.7 (2.6, 2.8)	2.2 (2.1, 2.3)	1.7 (1.7, 1.8)
Slovenia	4,337	2.6 (2.5, 2.6)	2.1 (2.1, 2.2)	1.6 (1.5, 1.7)	2.7 (2.6, 2.8)	2.3 (2.2, 2.3)	1.8 (1.7, 1.9)
Sweden	5,423	2.5 (2.4, 2.5)	2.2 (2.1, 2.2)	1.8 (1.7, 1.8)	2.7 (2.6, 2.7)	2.1 (2.1, 2.2)	1.7 (1.6, 1.8)
Hungary	4,151	2.6 (2.5, 2.7)	2.1 (2.0, 2.2)	1.6 (1.6, 1.7)	2.8 (2.7, 2.8)	2.2 (2.1, 2.3)	1.6 (1.5, 1.7)
Russia	4,371	2.3 (2.3, 2.4)	2.2 (2.1, 2.3)	1.9 (1.8, 2.0)	2.4 (2.3, 2.4)	2.1 (2.1, 2.2)	1.9 (1.8, 1.9)
Czech Republic	3,815	2.5 (2.4, 2.6)	2.2 (2.1, 2.2)	1.7 (1.6, 1.7)	2.8 (2.7, 2.8)	2.0 (2.0, 2.1)	1.6 (1.5, 1.7)
Netherlands	3,675	2.5 (2.4, 2.6)	2.2 (2.1, 2.3)	1.6 (1.5, 1.7)	2.7 (2.6, 2.7)	2.2 (2.1, 2.2)	1.5 (1.4, 1.6)
Denmark	2,876	2.5 (2.5, 2.6)	2.1 (2.0, 2.2)	1.5 (1.4, 1.6)	2.7 (2.7, 2.8)	2.2 (2.1, 2.2)	1.5 (1.4, 1.6)
Greece	3,610	2.5 (2.4, 2.5)	2.1 (2.0, 2.2)	1.6 (1.6, 1.7)	2.6 (2.5, 2.6)	2.1 (2.0, 2.1)	1.6 (1.5, 1.7)
Scotland	5,480	2.5 (2.4, 2.5)	2.1 (2.0, 2.1)	1.7 (1.7, 1.8)	2.6 (2.6, 2.7)	2.0 (1.9, 2.0)	1.6 (1.5, 1.6)
Greenland	575	2.6 (2.4, 2.8)	2.1 (1.9, 2.3)	1.4 (1.2, 1.7)	2.6 (2.5, 2.8)	2.0 (1.8, 2.2)	1.3 (1.0, 1.5)
Italy	4,058	2.3 (2.2, 2.3)	2.0 (1.9, 2.0)	1.5 (1.5, 1.6)	2.6 (2.5, 2.6)	2.0 (2.0, 2.1)	1.6 (1.5, 1.6)
Croatia	5,510	2.4 (2.3, 2.4)	2.1 (2.0, 2.1)	1.5 (1.4, 1.5)	2.6 (2.5, 2.6)	2.0 (2.0, 2.1)	1.4 (1.3, 1.4)
Wales	3,208	2.4 (2.3, 2.5)	2.0 (2.0, 2.1)	1.7 (1.6, 1.8)	2.5 (2.4, 2.5)	1.8 (1.7, 1.9)	1.5 (1.4, 1.6)
Estonia	2,805	2.3 (2.2, 2.4)	1.9 (1.8, 2.0)	1.4 (1.3, 1.5)	2.4 (2.3, 2.5)	1.7 (1.6, 1.8)	1.3 (1.3, 1.4)
Latvia	3,318	2.3 (2.2, 2.3)	1.8 (1.7, 1.9)	1.3 (1.3, 1.4)	2.3 (2.3, 2.4)	1.8 (1.7, 1.9)	1.2 (1.1, 1.3)
Finland^c c There were no data for adolescents aged 11 years. The comparison was made between those aged 15 and 13 years. Differences among ages were tested by ANCOVA. Analyses were adjusted for living with mother, living with father, having brothers or sisters and family affluence scale. In all countries, significant differences of mean of behavior reported among ages were observed (p < 0.001). Countries were sorted by the general mean of healthy behaviors reported.	3,103		2.4 (2.3, 2.5)	1.8 (1.7, 1.8)		2.3 (2.2, 2.3)	1.8 (1.7, 1.9)
Norway^c c There were no data for adolescents aged 11 years. The comparison was made between those aged 15 and 13 years. Differences among ages were tested by ANCOVA. Analyses were adjusted for living with mother, living with father, having brothers or sisters and family affluence scale. In all countries, significant differences of mean of behavior reported among ages were observed (p < 0.001). Countries were sorted by the general mean of healthy behaviors reported.	1,783		2.3 (2.2, 2.4)	1.7 (1.6, 1.8)		2.3 (2.2, 2.4)	1.7 (1.6, 1.8)

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[1] * Corresponding author. E-mail:amarques@fmh.ulisboa.pt (A. Marques).

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Adolescents' healthy lifestyle☆ ☆ Please cite this article as: Marques A, Loureiro N, Avelar-Rosa B, Naia A, Matos MG. Adolescents' healthy lifestyle. J Pediatr (Rio J). 2020;96:217-24.

Abstract

Objective:

Methods:

Results:

Conclusions:

Adolescents' healthy lifestyle^☆ ☆ Please cite this article as: Marques A, Loureiro N, Avelar-Rosa B, Naia A, Matos MG. Adolescents' healthy lifestyle. J Pediatr (Rio J). 2020;96:217-24.