Are senior high school students in Ghana meeting WHO's recommended level of physical activity? Evidence from the 2012 Global School-based Student Health Survey Data.
ABSTRACT: INTRODUCTION:Physical activity (PA) has both short- and long-term importance. In this study we sought to assess the prevalence and correlates of PA among 1,542 Senior High School (SHS) students. METHODS:A cross-sectional study was conducted in Ghana among SHS students using the 2012 version of the Ghana Global School-based Student Health Survey (GSHS) data, which utilised two-stage cluster sampling technique. The population for the study comprised SHS students. The outcome variable was physical activity. The data were analysed using STATA version 14.2 for Mac OS. Both bivariate and multivariate analyses were employed. At the bivariate level, Pearson chi-square test between each independent variable and PA was conducted and the level of statistical significance was set at 5%. All the significant variables from the chi-square test were selected for the multivariate analysis. In the multivariate analysis, Poisson regression with robust variance was performed to estimate crude and adjusted prevalence ratios (APR). RESULTS:It was found that 25.0% (29.0% males and 21.9% females) of SHS students were physically active. Female students (APR = 0.78, 95% CI = 0.65, 0.94), students in SHS 2 (APR = 0.76, 95% CI = 0.577, 0.941) and SHS3 (APR = 0.79, 95% CI = 0.63, 0.93), and those who went hungry (APR = 0.77, 95% CI = 0.65, 0.92) were less likely to be physically active compared to males, those in SHS1 and those who did not go hungry respectively. On the other hand, students who actively commuted to school (APR = 2.40, 95% CI = 1.72, 2.42) and got support from their peers were more likely to be physically active (APR = 1.62, 95% CI = 1.09-2.41). CONCLUSION:Only a quarter of SHS students who participated in the 2012 version of the GSHS met the WHO's recommended level of physical activity. Sex, grade/form and experience of hunger are associated with physical activity. Physical activity is a major component of any health promotion program. Policies and programmes targeting improvement in physical activity among SHS students should take these associated factors into consideration.
Project description:INTRODUCTION:Use of tobacco products among adolescents is a major global public health concern. Given the changing landscape of tobacco product use and the lack of epidemiologic data to inform tobacco prevention and control strategies in Kuwait, this study sought to estimate the prevalence and patterns of electronic cigarette (e-cigarette), conventional cigarette, and hookah use among adolescents in Kuwait. Moreover, exposure to secondhand smoke (SHS) and secondhand aerosol (SHA) from e-cigarettes was assessed. METHODS:This cross-sectional study enrolled high school students (n=1565; 16-19 years) across Kuwait. Current (past 30-day) use of e-cigarettes, conventional cigarettes, and hookah were assessed through self-reported data. Additionally, current (past 7-day) exposure to SHS and SHA in households and public places were ascertained. Associations were evaluated using Poisson regression, and adjusted prevalence ratios (APRs) and 95% confidence intervals (CIs) were estimated. RESULTS:Overall, 26.4% (402/1525), 25.1% (383/1525), and 20.9% (318/1525) of the study participants were current e-cigarette users, conventional cigarette smokers, and hookah smokers, respectively. Current use of any tobacco product was reported by 35.1% (535/1525) of the total study participants. The prevalence of concurrent triple use of 'e-cigarettes, conventional cigarettes, and hookah' was estimated to be 12.8% (195/1525). Also, among the study participants, 41.9% (619/1479) were exposed to household SHS, 32.0% (469/1465) were exposed to household SHA, and 62.2% (916/1472) were exposed to SHS and/or SHA in public places. Male adolescents were more likely than females to be current e-cigarette users (APR=5.19; 95% CI: 4.09-6.57), conventional cigarette smokers (APR=5.42; 95% CI: 4.26-6.90), and hookah smokers (APR=3.43; 95% CI: 2.72- 4.32). CONCLUSIONS:A substantial proportion of adolescents in Kuwait are currently using tobacco products and being exposed to SHS/SHA. The findings emphasize the need to continue monitoring all forms of tobacco product use among adolescents and to strengthen tobacco prevention and control programs.
Project description:INTRODUCTION:Secondhand smoking (SHS) may be a risk factor for obesity in adolescence, but data on the association between SHS and obesity are scarce, especially from low- and middle-income countries (LMICs). Therefore, the aim of this study was to assess the association between SHS and obesity among adolescents aged 12-15 years from 38 LMICs. METHODS:Cross-sectional data from 38 LMICs that participated in the Global School-based Student Health Survey (GSHS) were analyzed. Body mass index was calculated based on measured weight and height. The 2007 WHO Child Growth reference was used to define obesity. SHS was categorized as no exposure, non-daily exposure (ie, 1-6 days), and daily exposure (ie, 7 days) based on the number of days exposed to secondhand smoke in the past 7 days. Multivariable logistic regression and meta-analyses were conducted to assess the associations. RESULTS:The analyzed sample consisted of 88 209 adolescents aged 12-15 years who never smoked. The overall prevalence of non-daily and daily SHS was 34.2% and 15.7%, respectively. After adjustment for potential confounders, compared with no SHS, there was no significant association between non-daily SHS and obesity (odds ratio [OR] = 0.94; 95% confidence interval [CI] = 0.86-1.02), but adolescents who reported daily SHS were significantly more likely to have obesity (OR = 1.19; 95% CI = 1.06-1.34). CONCLUSIONS:The prevalence of SHS was high among adolescents in LMICs, and daily SHS was associated with a significant increase in odds of obesity. Future studies with longitudinal designs are warranted to assess causality and whether prevention of SHS can reduce the risk of obesity in adolescence. IMPLICATIONS:In the present large multi-country study on adolescents aged 12-15 years from LMICs, nearly half of the students were exposed to non-daily or daily secondhand smoke. Overall, while non-daily SHS was not significantly associated with obesity, adolescents who reported daily SHS had a significant 1.19 (95% CI = 1.06-1.34) times higher odds of obesity than those who reported no exposure to secondhand smoke. To the best of our knowledge, this is the first multi-country study on SHS and obesity from LMICs, and also the largest study on this topic to date.
Project description:Importance:The cultural roles and expectations attributed to individuals based on their sex often shape health behaviors and outcomes. Gender nonconformity (GNC) (ie, gender expression that differs from societal expectations for feminine or masculine appearance and behavior) is an underresearched area of adolescent health that is often linked to negative health outcomes. Objective:To examine the associations of GNC with mental distress and substance use among high school students. Design, Setting, and Participants:Cross-sectional study based on data from the Youth Risk Behavior Survey (YRBS) conducted in 2015. The setting was 3 large urban US school districts (2 in California and 1 in Florida). Participants were a racially/ethnically diverse population-based sample of 6082 high school students representative of all public school students in grades 9 through 12 attending these 3 school districts. Main Outcomes and Measures:Sex-stratified adjusted prevalence ratios (APRs) (adjusted for race/ethnicity, grade, and sexual identity) for high gender-nonconforming students (very/mostly/somewhat feminine male students or very/mostly/somewhat masculine female students) and moderate gender-nonconforming students (equally feminine and masculine students) relative to a referent group of low gender-nonconforming students (very/mostly/somewhat masculine male students or very/mostly/somewhat feminine female students). Results:Among 6082 high school students, 881 (15.9%) were white, 891 (19.1%) black, 3163 (55.1%) Hispanic, and 1008 (9.9%) other race/ethnicity. Among female students (2919 [50.0% of the study population]), moderate GNC was significantly associated with feeling sad and hopeless (APR, 1.22; 95% CI, 1.05-1.41), seriously considering attempting suicide (APR, 1.41; 95% CI, 1.14-1.74), and making a suicide plan (APR, 1.52; 95% CI, 1.22-1.89); however, substance use was not associated with GNC. Among male students (3139 [50.0% of the study population]), moderate GNC was associated with feeling sad and hopeless (APR, 1.55; 95% CI, 1.25-1.92); high GNC was associated with seriously considering attempting suicide (APR, 1.72; 95% CI, 1.16-2.56), making a suicide plan (APR, 1.79; 95% CI, 1.17-2.73), and attempting suicide (APR, 2.78; 95% CI, 1.75-4.40), as well as nonmedical use of prescription drugs (APR, 1.81; 95% CI, 1.23-2.67), cocaine use (APR, 2.84; 95% CI, 1.80-4.47), methamphetamine use (APR, 4.52; 95% CI, 2.68-7.61), heroin use (APR, 4.59; 95% CI, 2.48-8.47), and injection drug use (APR, 8.05; 95% CI, 4.41-14.70). Conclusions and Relevance:This study suggests mental distress is associated with GNC among female and male students. Substance use also appeared to be strongly associated with GNC among male students. These findings underscore and suggest the importance of implementing school-based programs to prevent substance use and promote student mental health that are inclusive of gender diversity in students.
Project description:BACKGROUND:Most Finnish adolescents are not sufficiently physically active. Health education (HE) provides beneficial starting point for physical activity (PA) promotion in schools. This study evaluates an intervention integrated into three HE lessons to increase PA and reduce sedentary behavior (SB) among eighth graders. METHODS:All public secondary schools in Tampere, Finland participated and were randomized to intervention (INT, n?=?7) and comparison group (COM, n?=?7). In INT (690 students, 36 classes) the teachers (n?=?14) implemented behavioral theory-driven content during three HE lessons. In COM (860 students, 41 classes) the teachers (n?=?14) carried out standard lessons. The evaluation was based on RE-AIM: Effectiveness was assessed from baseline to 4?weeks (Follow-up 1) and Maintenance from 4?weeks to 7?months (Follow-up 2) with change in students' PA and SB and related psychosocial and parental factors. Methods included questionnaire, accelerometer and activity diary. Linear mixed models with baseline adjustments and random effect correction were used to compare the difference in change between INT and COM. Data on Reach, Adoption and Implementation were collected during the process. RESULTS:Intervention effects were only seen in the self-reported data favoring INT in the weekly number of days with at least 1?h of brisk leisure PA (0.3 [95%CI 0.1 to 0.6]), proportion of students meeting PA recommendations (4.1 [95%CI 2.5 to 5.7]), proportion of students reporting that their family sets limitations for screen time (5.4 [95%CI 3.3 to 7.4]) and in the number of days on which the students intended to do leisure PA in the following week (0.3 [95%CI 0.1 to 0.6]). The effects on PA were still beneficial for INT at Follow-up 2. The intervention reached 96% of the students, was adopted in all 7 schools and was implemented by 13/14 teachers in 35/36 classes. CONCLUSIONS:The intervention was feasible and had small favorable effects on students' self-reported PA, intention to do PA and family norm in screen time. The effects on PA persisted until Follow-up 2. It is likely that for greater impacts the HE lessons should have been supported with other actions without compromising feasibility. TRIAL REGISTRATION:NCT01633918 (June 27th, 2012).
Project description:BACKGROUND:This study examined associations between students' physical fitness and physical activity (PA), as well as what specific physical fitness components were more significant correlates to being physically active in different settings for boys and girls. METHODS:A total of 265 fifth-grade students with an average age of 11 voluntarily participated in this study. The students' physical fitness was assessed using four FitnessGram tests, including Progressive Aerobic Cardiovascular Endurance Run (PACER), curl-up, push-up, and trunk lift tests. The students' daily PA was assessed in various settings using a daily PA log for 7 days. Data was analyzed with descriptive statistics, univariate analyses, and multiple R-squared liner regression methods. RESULTS:Performance on the four physical fitness tests was significantly associated with the PA minutes spent in physical education (PE) class and recess for the total sample and for girls, but not for boys. Performance on the four fitness tests was significantly linked to participation in sports/dances outside school and the total weekly PA minutes for the total sample, boys, and girls. Further, boys and girls who were the most physically fit spent significantly more time engaging in sports/dances and had greater total weekly PA than boys and girls who were not physically fit. In addition, the physically fit girls were more physically active in recess than girls who were not physically fit. CONCLUSIONS:Overall, students' performance on the four physical fitness tests was significantly associated with them being physically active during PE and in recess and engaging in sports/dances, as well as with their total weekly PA minutes, but not with their participation in non-organized physical play outside school. TRIAL REGISTRATION:ClinicalTrials.gov ID: NCT03015337 , registered date: 1/09/2017, as "retrospectively registered".
Project description:Background:Suboptimal health status (SHS) is an intermediate health status between health and illness, a syndrome characterised by the perception of health complaints, general weakness and low energy. This study aimed to investigate the prevalence of SHS and the correlation between SHS and psychological symptoms among Chinese college students and to identify the SHS-related risk factors from the perspective of predictive, preventive and personalised medicine (PPPM). Methods:A cross-sectional study was conducted among 4119 college students who were enrolled from Taishan Medical University and Baoji Vocational and Technical College in the eastern and western areas of China. SHS levels of the participants were measured by an established self-reporting Suboptimal Health Status Questionnaire-25 (SHSQ-25). Psychosomatic conditions were estimated by the self-rating Symptom Checklist-90 (SCL-90) scale. Spearman correlation analysis was applied to analyse the relationship between SHSQ-25 scores and SCL-90 estimates. Logistic regression analysis was applied for multivariate analysis. Results:The prevalence of SHS was 21.0% (864/4119), with 23.3% (701/3005) for female students and 14.6% (163/1114) for male students. The prevalence of general positive psychological symptom was 14.2% (586/4119), with 15.6% (470/3005) for female students and 10.4% (116/1114) for male students. A strong correlation was identified between SHS score and SCL-90 estimates, with the correlation coefficient (r) of 0.719. Logistic regression showed that variables significantly associated with SHS were somatisation (adjusted odds ratio (aOR)?=?3.185, 95% confidence interval [CI]?=?2.048-4.953), obsessive-compulsive (aOR?=?3.518, 95% CI?=?2.834-4.368), interpersonal sensitivity (aOR?=?1.883, 95% CI?=?1.439-2.463) and depression (aOR?=?1.847, 95% CI?=?1.335-2.554). Conclusions:Our findings confirm that there is a high prevalence of SHS among college students and there is a strong association between SHS and psychological symptoms among Chinese college students. High susceptibility of SHS occurs particularly in vulnerable groups: female students, sophomore students, medical students and students from rural area. Identification of SHS and prompt application of personalised psychological health-supporting activities will promote college students' health status.
Project description:Persistent worry can cause significant distress among adolescents. The goal of this study was to estimate the prevalence and correlates of worry-induced sleep disturbance (WISD) among adolescent school children in Lebanon. Cross-sectional, nationally representative data were analysed from 5849 adolescents (15 years median age) that took part in the "2017 Lebanon Global School-Based Student Health Survey (GSHS)". The results indicate that the prevalence of WISD was 14.7%, 9.6% among males and 17.2% among females. In adjusted logistic regression analysis, loneliness, older age, female sex, having no close friends, infrequent bullying victimization, parents disrespected privacy, current tobacco use, ever cannabis use, high leisure-time sedentary behaviour and having sustained multiple serious injuries (past year) were associated with WISD. In addition, in unadjusted analysis, mostly or always feeling hungry (or low economic status), school truancy, having been physically attacked, frequently being in physical fights (past year), low peer support, parental emotional neglect, parents never checking homework, ever drunk and frequent soft drink intake were positively, and infrequent fast food intake was negatively, associated with WISD. One in seven students reported WISD and several associated factors were identified, which can aid intervention strategies. Multi-level interventions are needed targeting psychosocial distress, social-environmental factors and health risk behaviours to prevent WISD in this adolescent school population.
Project description:Chinese children are facing health challenges brought by chronic non-communicable diseases, such as physical problems and psychological related health problems. Childhood represents a critical life period when the long-term dietary and lifestyle behaviors are formed. It is necessary to survey the prevalence of suboptimal health status (SHS) among Chinese children and to research the relationship between SHS and lifestyles. This study aimed to examine the prevalence of SHS among Chinese children using a large-scale population survey sample covering school students and nonstudent children, and clarified the relationships between SHS and lifestyle factors using multi-level models controlled for the cluster effect of location and the confounding effect of demographics. Multi-level generalized estimating equation models were used to examine the relationships between SHS and lifestyle factors. Prevalence ratios (PR) and 95% confidence intervals (CI) were used to assess the strength of these relationships. Of the 29,560 children, 14,393 reported one or more SHS symptoms, giving a SHS prevalence of 48.69%. The prevalence of SHS for boys (46.07%) was lower than that for girls (51.05%). After controlling for the cluster effect of living areas and confounding effect of demographic characteristics, lifestyle factors associated with SHS were: less sleep duration, current smokers (PR = 1.085, 95%CI: 1.027-1.147), current drinkers (PR = 1.072, 95%CI: 1.016-1.131), children' parents suffering from chronic diseases (PR = 1.294, 95%CI: 1.179-1.421), poor sleep quality (PR = 1.470, 95%CI: 1.394-1.550), stress (PR = 1.545, 95%CI: 1.398-1.707), negative life events (PR = 1.237, 95%CI: 1.088-1.406), hypertension (PR = 1.046, 95%CI: 1.009-1.084), unhealthy diet choice (PR = 1.091, 95%CI: 1.051-1.133) and irregular meal time (PR = 1.210, 95%CI: 1.163-1.259). Children who could exercise regularly (PR = 0.897, 95%CI: 0.868-0.927) and those with regular medical checkup (PR = 0.891, 95%CI: 0.854-0.929) were associated with lower prevalence probability of SHS. SHS has become a serious public health challenge for Chinese children. Unhealthy lifestyles were closely associated with SHS. Implementation of preventative strategies are needed to reduce the potential SHS burden associated with these widespread high-risk unhealthy lifestyle behaviors.
Project description:INTRODUCTION:Detrimental effects of secondhand smoke (SHS) exposure are well established; however, data on SHS exposure among adolescents in Kuwait are lacking. Hence, this study sought to estimate the prevalence of household SHS exposure among two samples of adolescents in Kuwait and assess its variation by socioeconomic status and parental education level. METHODS:Data from two large school-based cross-sectional studies were analyzed. Adolescents attending public middle (n=3864; aged 11-14 years) and high (n=1959; aged 14-19 years) schools throughout Kuwait were enrolled in 2016-2017, and parental self-reported household SHS exposure was ascertained. Associations were assessed using Poisson regression with robust variance estimation, and adjusted prevalence ratios (APRs) and 95% confidence intervals (CIs) were estimated. RESULTS:Overall, 45.8% (1755/3836; 95% CI: 44.2-47.3%) of the enrolled middle school students and 51.6% (998/1936; 95% CI: 49.3-53.8%) of the enrolled high school students were exposed to household SHS. Among middle and high school students, the prevalence of household SHS exposure increased as maternal/paternal education level and family income decreased. Among middle school students, paternal educational attainment of middle school or less compared to bachelor's degree or higher was associated with 1.60 times (95% CI: 1.44-1.79) higher household SHS exposure. Similarly, in the sample of middle school students, the prevalence of household SHS exposure significantly increased from 35.8% among children from families reporting the highest household income to 50.5% among children from families with the lowest reported household income (p-trend<0.001). CONCLUSIONS:Household SHS exposure is substantially high among adolescents in Kuwait. Enrolled adolescents from families with low socioeconomic status or with low parental education level have the highest household SHS exposure. These findings highlight the need for national comprehensive tobacco control policies and increasing parental awareness of the impact of SHS exposure on children.
Project description:BACKGROUND:Global physical activity levels are low. Active commuting to school is a low-cost and sustainable behaviour that promotes adolescents' physical activity levels. Despite its importance, data on low- and middle-income countries is scarce. This study aimed to assess the relationship between active commuting to school and physical activity (PA) levels among 11-16 years-old adolescents from 63 low- and middle-income countries and six world regions. METHODS:Data were from the GSHS database. Participants were 187,934 adolescents (89,550 boys), aged 11-16 years-old, from 63 low- and middle-income countries. Active commuting to school and PA were self-reported as the number of days adolescents walked or cycled to school and engaged in physical activity for at least 60 min in the past 7 days. RESULTS:Boys and girls who actively commuted to school presented higher prevalence of attaining the PA recommendations, but only for the 13-14 (boys: 16.6% versus 22.0%; girls: 9.8% versus 14.6%) and 15-16 (boys: 16.3% versus 21.6%; girls: 8.0% versus 14.0%) year-old age groups. Only for Oceania, Central Asian, Middle Eastern, and North African girls and Sub-Saharan African boys no difference was found in the prevalence of attaining the PA recommendations between those who actively commuted to school and those who did not. Boys who actively commuted to school were 42% (95% CI: 1.37, 1.46) more likely to achieve the PA recommendations, while girls were 66% (95% CI: 1.59, 1.73) more likely to achieve the PA recommendations. CONCLUSIONS:Active commuting to school is associated with the adolescents' physical activity levels. However, it may have a lesser influence in helping younger adolescents attaining physical activity recommendations. Public health authorities should promote active commuting to school among adolescents in order to improve the PA levels and promote health.