Independent and combined effects of lifestyle behaviors on adolescent health-related quality of life.

OBJECTIVE: To investigate the independent and combined effects of lifestyle behaviors, including physical activity, sedentary behavior, sleep duration and food intake, in the health-related quality of life (HRQoL) of Brazilian adolescents. METHODS: Cross-sectional school-based study, with the participation of 306 adolescents aged 14 to 18 years. A questionnaire was applied with structured questions to collect lifestyle behaviors data. Perception of the HRQoL was identified using the Kidscreen-27. The study used covariance analysis and linear regression models for statistical analysis. RESULTS: Adolescents who reported ≤ 2 hours/day of screen-based sedentary behavior and sleep duration equivalent to 8-10 hours/night presented significantly higher HRQoL. Adolescents who reported joint adherence ≥ 3 healthy lifestyle behaviors demonstrated approximately two [OR=2.12] to three times [OR=3.04] more chance of presenting higher perceptions of HRQoL. CONCLUSION: Although healthy lifestyle behaviors had a positive independent effect on HRQoL, joint adherence to healthy behaviors enhances the cumulative effect.

Health-promoting domains and lifestyle of a sample of Brazilian adolescents.

BACKGROUND: Reports indicate that the health habits of adults are strongly linked to the behaviors incorporated in adolescence. Therefore, it is essential to monitor the lifestyle of adolescents to promote their present and future health. This study aimed to identify differences in health-promoting domains according to demographic data and lifestyle behaviors, including physical activity, sedentary behavior, sleep duration, and food intake, in a sample of Brazilian adolescents. MATERIALS AND METHODS: Cross-sectional school-based study, with the participation of 306 adolescents aged 14 to 18 years. A questionnaire was applied with structured questions to collect demographic data and lifestyle behaviors. To examine the health-promoting domains the Adolescent Health Promotion Scale (AHPS) was used. Data were analyzed using multivariate analysis. RESULTS: Scores attributed to each of the health-promoting domains showed substantial variations according to sex, age, year of study, parents' schooling, and family economic class. After adjustment for covariables, the adolescent who presented significantly higher scores equivalent to the overall index of health promotion reported being more physically active (F = 4.848; P = 0.009), sleeping 6-8 hours/night (F = 2.328; P = 0.046), consuming fruit/vegetable more frequently (F = 3.168; P = 0.024), while sedentary behavior and intake of sweetened products/soft drinks have not shown any significant effect. CONCLUSION: The findings confirmed the consistent positive influence of health-promoting domains assessed by AHPS on healthy lifestyle behaviors, suggesting in the intervention programs aimed at adopting healthy lifestyle approaches it is important enough to contemplate actions aimed at all the areas of health promotion with characteristics aimed at nutrition behavior, social support, health responsibility, life appreciation, exercise behavior, and stress management.

Independent and combined effects of lifestyle behaviors on adolescent health-related quality of life / Efectos individuales y combinados de conductas del estilo de vida en la calidad de vida relacionada a la salud de adolescentes / Efeitos individual e combinado de condutas do estilo de vida na qualidade de vida relacionada à saúde de adolescentes

ABSTRACT Objective: To investigate the independent and combined effects of lifestyle behaviors, including physical activity, sedentary behavior, sleep duration and food intake, in the health-related quality of life (HRQoL) of Brazilian adolescents. Methods: Cross-sectional school-based study, with the participation of 306 adolescents aged 14 to 18 years. A questionnaire was applied with structured questions to collect lifestyle behaviors data. Perception of the HRQoL was identified using the Kidscreen-27. The study used covariance analysis and linear regression models for statistical analysis. Results: Adolescents who reported ≤ 2 hours/day of screen-based sedentary behavior and sleep duration equivalent to 8-10 hours/night presented significantly higher HRQoL. Adolescents who reported joint adherence ≥ 3 healthy lifestyle behaviors demonstrated approximately two [OR=2.12] to three times [OR=3.04] more chance of presenting higher perceptions of HRQoL. Conclusion: Although healthy lifestyle behaviors had a positive independent effect on HRQoL, joint adherence to healthy behaviors enhances the cumulative effect.

RESUMEN Objetivo: Investigar los efectos individuales y combinados de conductas del estilo de vida, incluyendo actividad física, conducta sedentaria, sueño y ingestión de alimentos, en la calidad de vida relacionada a la salud (CVRS) de adolescentes brasileños. Métodos: Estudio observacional de base escolar, con participación de 306 adolescentes de 14 a 18 años. Fue aplicada encuesta con cuestiones estructuradas para recoger datos de conductas del estilo de vida. Percepción de la CVRS fue identificada por medio del Kidscreen-27. Análisis de covarianza y modelos de regresión linear fueron usados para análisis estadístico. Resultados: Adolescentes que apuntaron ≤ 2 horas/día de conducta sedentaria basado en pantalla y duración de sueño entre 8-10 horas/noche tuvieron CVRS significativamente más elevada. Adolescentes que relataron adherencia conjunta ≥ 3 conductas saludables del estilo de vida demostraron aproximadamente de dos [OR=2,12] a tres veces [OR=3,04] más chance de presentar percepciones más elevadas de CVRS. Conclusión: Aunque conductas saludables del estilo de vida resulten en efecto individual positivo sobre la CVRS, adherencia conjunta de conductas saludables potencializa el efecto acumulativo.

RESUMO Objetivo: Investigar os efeitos individual e combinado de condutas do estilo de vida, incluindo atividade física, comportamento sedentário, sono e consumo alimentar, na qualidade de vida relacionada à saúde (QVRS) de adolescentes brasileiros. Métodos: Estudo observacional de base escolar, com participação de 306 adolescentes de 14 a 18 anos. Foi aplicado questionário com questões estruturadas para levantar dados de condutas do estilo de vida. Percepção da QVRS foi identificada por meio do Kidscreen-27. Análise de covariância e modelos de regressão linear foram usados para análise estatística. Resultados: Adolescentes que apontaram ≤ 2 horas/dia de comportamento sedentário baseado em tela e duração de sono entre 8-10 horas/noite apresentaram QVRS significativamente mais elevada. Adolescentes que relataram adesão conjunta ≥ 3 condutas saudáveis do estilo de vida demonstraram aproximadamente de duas [OR=2,12] a três vezes [OR=3,04] mais chance de apresentarem percepções mais elevadas de QVRS. Conclusão: Embora condutas saudáveis do estilo de vida apresentaram efeito individual positivo sobre a QVRS, adesão conjunta de condutas saudáveis potencializaram o efeito cumulativo.

Adherence to Combined Healthy Movement Behavior Guidelines among Adolescents: Effects on Cardiometabolic Health Markers.

BACKGROUND: The combined movement behavior guidelines for adolescents recommend ≥60 min of moderate to vigorous physical activity, ≤2 h of screen time, and 8-10 h of sleep. Considering that the information available on this topic in the young Latin American population is rare, this study aimed to identify the proportion of a sample of Brazilian adolescents meeting individual guidelines as well as the combination of the three healthy movement behavior guidelines. In addition, another objective of the study was to examine the effects of compliance with these guidelines on cardiometabolic health markers. METHODS: This is a cross-sectional school-based study, with the participation of 306 adolescents aged 14 to 18 years. A questionnaire with structured questions was applied to collect data on physical activity, screen time, and sleep duration. Cardiometabolic health was assessed by the calculation of a continuous risk score, including twelve markers related to body fat, blood pressure, plasma lipids and lipoproteins, glycemia, and insulin. RESULTS: Only 4.8% (4.3-5.4) of the adolescents met the three healthy movement behavior guidelines, while 9.3% (8.4-10.4) of the sample did not meet any of the guidelines. No significant difference between sexes was found in the simultaneous compliance of the three movement guidelines. Adolescents who did not meet any of the movement guidelines were twice as likely to have higher cardiometabolic risk (OR = 2.05 (1.41-3.17)) than their peers who met all three guidelines. CONCLUSIONS: Considering the high proportion of adolescents who did not meet the movement behavior guidelines and the negative effects on cardiometabolic health, it is suggested that future policies and interventions should consider an integrated and holistic approach aimed at simultaneous actions of maximizing physical activity, minimizing screen time, and ensuring sufficient sleep duration.

Psychometric Properties of the Brazilian Version of the Adolescent Health Promotion Scale (AHPS). / Propriedades Psicométricas da Versão Brasileira da Adolescent Health Promotion Scale (AHPS).

This study aimed to translate into Portuguese, perform the cross-cultural adaptation and verify the psychometric properties of the Adolescent Health Promotion Scale (AHPS) for use in Brazilian adolescents. The original version was translated following international recommendations. The final version of the translated scale was administered to a sample of 1,949 adolescents of both genders aged 12-18 years. An exploratory factor analysis and then a confirmatory factor analysis were completed to identify the baseline psychometric properties. After minor changes identified in the translation process, the committee of experts considered that the Portuguese version of the AHPS showed semantic, idiomatic, cultural and conceptual equivalence. The factor analysis confirmed the structure of six subscales originally proposed, by statistical indicators equivalent to χ2/df=1.83, CFI=0.948, GFI=0.969, AGFI=0.956 and RMSR=0.052. Factor validity and reliability were confirmed by suitable factor loadings and desirable realms of composite reliability (>0.7) average variance extracted (>0.5). In conclusion, translation, cross-cultural adaptation and psychometric properties of the AHPS were satisfactory, thus enabling its application in future Brazilian studies.

Os objetivos do estudo foram traduzir para o idioma português, realizar adaptação transcultural e verificar propriedades psicométricas da Adolescent Health Promotion Scale (AHPS) para uso em adolescentes brasileiros. Versão original foi traduzida de acordo com recomendações internacionais. Versão final da escala traduzida foi administrada em uma amostra de 1.949 adolescentes de ambos os sexos com idade entre 12 e 18 anos. Para identificar as propriedades psicométricas iniciais foi realizada análise fatorial exploratória e, na sequência, análise fatorial confirmatória. Após discretas modificações apontadas no processo de tradução, comitê de juízes considerou que a versão para o idioma português da AHPS apresentou equivalências semântica, idiomática, cultural e conceitual. Análise fatorial confirmou estrutura de seis subescalas originalmente proposta, mediante indicadores estatísticos equivalentes a χ2 /gl=1,83, CFI=0,948, GFI=0,969, AGFI=0,956 e RMSR=0,052. Validade fatorial e confiabilidade foram confirmadas mediante adequadas cargas fatoriais e desejáveis dimensões de confiabilidade composta (>0,7) e variância média extraída (>0,5). Concluindo, tradução, adaptação transcultural e propriedades psicométricas da AHPS foram satisfatórias, o que viabiliza sua aplicação em futuros estudos no Brasil.

Propriedades Psicométricas da Versão Brasileira da Adolescent Health Promotion Scale (AHPS) / Psychometric Properties of the Brazilian Version of the Adolescent Health Promotion Scale (AHPS)

Resumo Os objetivos do estudo foram traduzir para o idioma português, realizar adaptação transcultural e verificar propriedades psicométricas da Adolescent Health Promotion Scale (AHPS) para uso em adolescentes brasileiros. Versão original foi traduzida de acordo com recomendações internacionais. Versão final da escala traduzida foi administrada em uma amostra de 1.949 adolescentes de ambos os sexos com idade entre 12 e 18 anos. Para identificar as propriedades psicométricas iniciais foi realizada análise fatorial exploratória e, na sequência, análise fatorial confirmatória. Após discretas modificações apontadas no processo de tradução, comitê de juízes considerou que a versão para o idioma português da AHPS apresentou equivalências semântica, idiomática, cultural e conceitual. Análise fatorial confirmou estrutura de seis subescalas originalmente proposta, mediante indicadores estatísticos equivalentes a χ2 /gl=1,83, CFI=0,948, GFI=0,969, AGFI=0,956 e RMSR=0,052. Validade fatorial e confiabilidade foram confirmadas mediante adequadas cargas fatoriais e desejáveis dimensões de confiabilidade composta (>0,7) e variância média extraída (>0,5). Concluindo, tradução, adaptação transcultural e propriedades psicométricas da AHPS foram satisfatórias, o que viabiliza sua aplicação em futuros estudos no Brasil.

Abstract This study aimed to translate into Portuguese, perform the cross-cultural adaptation and verify the psychometric properties of the Adolescent Health Promotion Scale (AHPS) for use in Brazilian adolescents. The original version was translated following international recommendations. The final version of the translated scale was administered to a sample of 1,949 adolescents of both genders aged 12-18 years. An exploratory factor analysis and then a confirmatory factor analysis were completed to identify the baseline psychometric properties. After minor changes identified in the translation process, the committee of experts considered that the Portuguese version of the AHPS showed semantic, idiomatic, cultural and conceptual equivalence. The factor analysis confirmed the structure of six subscales originally proposed, by statistical indicators equivalent to χ2/df=1.83, CFI=0.948, GFI=0.969, AGFI=0.956 and RMSR=0.052. Factor validity and reliability were confirmed by suitable factor loadings and desirable realms of composite reliability (>0.7) average variance extracted (>0.5). In conclusion, translation, cross-cultural adaptation and psychometric properties of the AHPS were satisfactory, thus enabling its application in future Brazilian studies.