Volume 32, Issue 2

Intuitive eating, which can be defined as reliance on physiological hunger and satiety cues to guide eating, has been proposed as a healthy weight management strategy. To date, there has not been a published study on intuitive eating in the context of Malaysia. Therefore, this cross-sectional study aims to determine associations between body weight status, psychological well-being and disordered eating behaviors with intuitive eating among undergraduate university students. A total of 333 undergraduate respondents (21.3% males and 78.7% females) from three randomly selected faculties in a public university in Malaysia participated in this study. Respondents completed a self-administered questionnaire which featured socio-demographic characteristics, intuitive eating, self-esteem, body appreciation, general unconditional acceptance, body acceptance by others, body function and disordered eating. Body weight, height, body fat percentage and waist circumference were measured. The results from this study revealed that there was no difference ( t  = 0.067, p = 0.947) in intuitive eating scores between males (75.69 ± 7.16) and females (75.62 ± 7.90). Multiple linear regression results have shown that body appreciation ( β  = 0.385, p < 0.001) and disordered eating ( β  = −0.168, p = 0.001) were significant predictors of intuitive eating, which accounted for 19.6% of the variance in intuitive eating. Health promotion programs should highlight the importance of enhancing body appreciation and preventing disordered eating behaviors among university students in order to promote intuitive eating as one of the healthy weight management approaches.

Objective To determine if secondary school students in New Zealand who report greater health concerns (e.g. significant depressive symptoms) are more likely to use the Internet to access health-related information. Methods A nationally representative health and wellbeing survey was undertaken in 2012 (n = 8500). Multiple regression models were used to examine the associations between students’ use of the Internet to access health-related information and selected outcomes or indicators. Results Over 90% of students used the Internet on a daily basis, with 15.4% of students reporting that they had used the Internet to access health-related information. Students experiencing household poverty were more likely to report not using the Internet daily (17.4% compared to 4.2%). Odds ratios (ORs) for accessing the Internet for this sort of information were highest for students who reported self-harm [OR 2.7, 95% confidence interval (CI) 2.3–3.3], disordered eating (OR 2.7, 95% CI 2.4–3.2), or a suicide attempt (OR 2.5, 95% CI 1.9–3.3). Conclusion Our findings suggest that Internet-based health interventions may be a viable way to reach young people with high health needs, but consideration needs to be given to those with limited Internet access.

Background Evidence suggests that there are differences in medicine habits among adolescents with different sociodemographic backgrounds and that peers might also influence medicine use. More knowledge is needed regarding how these aspects together affect how different young people use medicines. Objective To explore the differences in medicine use, perceptions and sharing between adolescents at two different educational (and socio-demographic) settings and assess the influence of parents and peers. Subjects Fifty-nine students from a private high school (HS) and 34 students from a public vocational school (VS) in Denmark between the ages of 15 and 19 years old were subjects in this study. Methods A questionnaire was used that included background, medicine consumption, perceptions and social interaction. Descriptive analyses along with a Fishers test were used to determine differences and similarities between students’ medicine patterns at the school settings. Results Of the 93 respondents, 74% used medicine within the past month, with females using more medicines. A significant difference was found with students at the VS using a higher number of medicines. Analgesics were the most frequently consumed medicine; however, reasons for using medicines appear to vary between the schools. Similarities between the schools were identified for perception of safety, sharing medicine and talking primarily with parents about medicine. Conclusion Fewer differences between students’ medicine use at two educational settings than expected were identified, showing that aspects other than social background influence adolescents’ use of medicine. A general tendency among young people believing that using medicines is a safe might explain these findings.

Objective African Americans adolescents have disproportionately high rates of obesity compared to their Caucasian peers. Little is known about the rates of obesity among adolescents of African descent in countries with diverse populations. Therefore, we aimed to determine the prevalence of obesity and weight-related behaviors among adolescents in Trinidad and Tobago and to explore differences by race and gender. Methods In this cross-sectional study, students from a national stratified sample of high schools (n = 42) in Trinidad and Tobago completed a self-administered survey regarding their health habits. Body mass index (BMI) was calculated from measured height (via a portable stadiometer) and weight (via a digital scale), and BMI percentiles determined using Centers for Disease Control and Prevention (CDC) growth charts. Univariate calculations and χ 2 analyses were performed to determine obesity prevalence and explore associations between obesity and self-reported demographic factors and weight-related behaviors. One-way analysis of variance (ANOVA) was used to test mean difference in weight status and multivariate analyses explored the role of gender and race after adjusting for covariates. Results Of the 3618 adolescents in the study, 56.3% were female. Race: 31.9% Black-Trinidadian, 33.7% Indo-Trinidadian and 33.4% Mixed-Race. Mean age was 17.6 years. The overall prevalence of obesity was 7%, but this differed by race (Black-Trinidadians 17%, Mixed-Trinidadians 2%, Indo-Trinidadians 1%). Black-Trinidadian girls were most likely to be obese (28.1%) and to engage in obesity related habits than their peers. Conclusion Black-Trinidadian girls have a significantly higher prevalence of obesity than their peers. Further work should explore culturally tailored interventions to address obesity prevention and treatment in this group.

There seems to be a lack of consensus about whether greater screen time is highly correlated to greater body mass index (BMI) (and lower physical exercise). What has been proven is that the vast majority of children and adolescents spend a “lot of time” indulging in screen-based leisure. The aim of this study was to investigate, among young adults, screen time and physical activity/fitness. A questionnaire was developed and circulated to young adults via media networks (i.e. email, social media platforms, etc.). There was no geographic restriction, and the survey was designed in English. Two people did not consent to the study, while 262 consented and completed the survey. The vast majority of participants resided in Canada, with a noticeable minority living in the United Kingdom and the United States. Of the participants, 46% were 18 or 19 years old, 30% were between the ages of 20 and 22 years and the remaining 24% were split evenly between the age cohorts of under 18 years and over 22 years. Four of 262 (2%) participants did not disclose their sex, 66% reported as female and 32% noted they were male. The BMI ranged from 14.4525 to 39.5325, and had a mean of 22.8155 and standard deviation of 4.1939. Among people who spent less than 4 h of exercise a week, those who spent more than 5 h on screen time based activities had a higher BMI (p = 0.0032) of 23.8151 vs. 21.7879 for those who spent less than 5 h. There was no relation between screen time and BMI among people who spent more than 4 h of exercise a week (p = 0.6209). Between exercise groups who spent less than 5 h of screen time a day, there was no relation between hours of exercise and BMI (p = 0.1242). There seems to exist a trend that among those who spend more than 5 h of screen time a day, less exercise is related to higher BMI (p = 0.0510) – 23.8151 vs. 22.4361. Healthy lifestyle choices such as fewer screen time hours and more exercise can be beneficial to young adults. Among certain groups, such as those who spend a lot of time on screens and those who do not exercise regularly, the benefits of more exercise and less screen time, respectively, are much more noticeable.

Objective The aim of the study was to measure the effects on levels of anxiety in healthy teenagers caused by a temporary change of country and school during a study abroad program. Methods In a prospective study we gathered the data from six anxiety level related tests on high school participants in a study abroad program (age 15–17, n = 364, M 172, F 192). These volunteer participants were divided into two separate groups: with self-reported elevated levels of anxiety (n = 111; YES-group) and with self-reported normal levels of anxiety (n = 253; NO-group). Two control groups of schoolchildren drawn from two local schools were used for comparison (n = 100 each). Three tests were subjective, i.e. self-fill-out tests. The next three tests were objective psychological or neurophysiological tests designed to estimate reflex control, concentration and a feeling for the passage of time. Results The initial mean anxiety level score among the 364 participants was 41.5 ± 16.7 (min 16, max 80) on 5–110 scale. For the YES-group the score was 56.5 ± 15.9, and for the NO-group the score was 34.7 ± 17.4 (p = 0.05). The retesting after they had been in the same place for 7 weeks revealed that the mean anxiety level score of the participants decreased to 37.4 ± 16.9 (min 15, max 72). For the YES-group the score significantly decreased to 39.3 ± 15.5, and for the NO-group the score slightly elevated to 36.7 ± 16.4 producing similar results for both groups (p = 0.81). Conclusion A temporary change of country and school at first results in a rise in anxiety levels in about one third of participants. However, after an extended stay it falls to normal levels.

Background One of the significant outcomes of health education is health literacy (HL), which should be expanded to improve health promotion. Objective The aim of this study was to assess HL and its relationship with Body Mass Index (BMI) in female adolescent students. Subjects This study was conducted on 235 female students (aged 13–15 years) which were selected with cluster sampling. Methods For assessing HL, the Newest Vital Sign (NVS) was used and BMI Z-score was evaluated following the World Health Organization (WHO) guidelines. Data were analyzed using SPSS version 16. Results Based on this study’s results, 11.5%, 37% and 51.5% of adolescents had adequate HL, limited HL and inadequate HL, respectively. There was a negative correlation between adolescents HL and BMI, r s = −0.233 (p < 0.001). Conclusion Most of adolescents had limited HL and students with higher BMI had a worse HL score. As a matter of fact, as adequate HL has a significant role for promoting health in the society policy makers must design educational programs for adolescents especially in non-medical settings such as schools where adolescents spend most of their time.

Background The overall goal of this study was to determine the causative factors for pregnancy status in adolescent girls in two communities in the Lagos Island local government area. Methods A mixed methods (quantitative and qualitative) study reviewing routine health facility antenatal care (ANC) records and conducting focus group discussions among 46 pregnant adolescents, exploring their views about sex, contraception, pregnancy and sexual and reproductive health (SRH) services, was carried out. Key informant interviews were also carried out among healthcare workers and community members to assess their perceptions of adolescents’ SRH problems. Results Five percent of those accessing ANC services were adolescents. Pregnant adolescents were found to access health services at later stages of their pregnancies due to the shame and stigma associated with their condition. The presence of morbidity in the form of anaemia (33%) and HIV (2.4%) was also found in this population. Social factors such as peer pressure and the desire to develop or maintain a relationship were found to be the major reasons for initiation of sexual activity by the adolescents. There was generally poor knowledge and utilisation of contraceptives, leading to unprotected sex and, thus, unintended pregnancies. Conclusion SRH information and services should be made readily available to adolescents at all levels of care.

Background This study tests the buffering effects of positive youth development (PYD) factors against depression and suicidal ideation across Hong Kong and Dutch students. Methods We collected data on depression, suicidal ideation, history of childhood maltreatment, and PYD from 565 Dutch and Hong Kong undergraduates. The three PYD factors, prosocial attributes, positive identity, and cognitive-behavioral competence, were examined for their moderating role in the relationship among childhood maltreatment, depression, and suicidal ideation in path analysis. Results Direct protective effects are found for all PYD factors in both cultures, except for cognitive-behavioral competence in the Dutch sample. A buffering effect of the PYD factors is observed in the maltreatment-depression relationship in Dutch, but not in Hong Kong students. Only behavioral competence buffers against suicidal ideation in Dutch students, while other PYD factors show no buffering effect in both groups of participants. Conclusion The differences in relationships between two samples highlights the need to consider cultural differences.

Background Nowadays, in Iran cesarean rates have increased from the recommended level of the World Health Organization (WHO). Objectives The objective of the present study was to determine which theory of planned behavior (TPB) constructs predict intentions and delivery mode among pregnant women. Methods One hundred and four pregnant nulliparous women in their third trimesters of pregnancy referred to Semirom health care centers were investigated based on census reports. The data were collected by valid and reliable questionnaire based on the TPB constructs and analyzed by SPSS16. Results In examining predictors using linear regression analysis to choose normal vaginal delivery (NVD), all constructs of TPB, including attitude toward NVD (p < 0.0001), subjective norms (p < 0.05) and perceived behavioral control (p < 0.001) were significantly correlated. Finally, after telephone follow-up with the women who had delivered newborns on their delivery method, it was found that 71.15% had a NVD and 28.14% had a cesarean delivery. Conclusions Regarding the effect of attitude to NVD, subjective norms and perceived behavioral control in NVD intention and its crucial role in anticipating the final delivery method, it is recommended considering these constructs in designing educational interventions for safe delivery in the investigated area.

Background Association of hyperuricemia, dyslipidemia and high blood pressure (BP) among adolescents with high waist-to-height ratio (WHtR) remains not fully addressed and could represent a new way to diagnose adolescents early with cardiometabolic risk. Objective We aimed to determine abdominal obesity (AO) prevalence and investigate relations between AO, uric acid (UA), lipid profiles, BP and geographical patterns in adolescents. Subjects 577 and 204 Algerian students aged between 10 and 19 years were included in our epidemiological and biochemical studies, respectively. Methods Height, weight, waist circumference (Wc) and hip circumferences, body mass index (BMI) and BP were measured. Fasting blood sampling was performed to measure glycemia, lipid profile, uricemia, insulinemia and leptinemia. The WHtR ≥0.50 was applied for the diagnosis of AO and geodemographics was evaluated. Results The prevalence of AO was 12.13% among all students, 19.17% and 16.39% among students living in urban and plain areas, respectively. The risk of AO may be reduced in rural and mountainous areas. Lipid parameters, UA, insulin and leptin serum concentrations were significantly increased in adolescents with WHtR ≥0.50 compared to those with WHtR <0.50. Cardiometabolic risk was increased with WHtR ≥0.50 and BMI >26. Means of BMI, Wc, BP, and lipid parameters were significantly increased in the fourth quartiles compared to the first quartile of UA. Conclusion Urban areas and plains represent factors contributing to AO and WHtR ≥0.50 may be used as a cut-off point to define risks of high BP, lipid abnormalities and UA serum level in Algerian adolescents.

Objective To examine, in a nationally-representative sample of high school students, to what extent one or more additional threats to physical safety exacerbates the risk of sadness and suicidality among victims of school and/or cyber-bullying. Methods National data from the 2015 Youth Risk Behavior Survey (YRBS) were analyzed for grades 9–12 (n = 15,624). Victimization groups were characterized by school-bullying and cyber-bullying, with and without additional threats to physical safety: fighting at school, being threatened/injured at school, and skipping school out of fear for one’s safety. Outcomes included 2-week sadness and suicidality. Outcomes for victimization groups were compared to non-victims using logistic regression adjusting for sex, grade and race/ethnicity. Results Overall, 20.2% of students were school-bullied, and 15.5% were cyber-bullied in the past year. Compared to non-victims, victims of school-bullying and victims of cyber-bullying (VoCBs) who did not experience additional threats to physical safety were 2.76 and 3.83 times more likely to report 2-week sadness, and 3.39 and 3.27 times more likely to exhibit suicidality, respectively. Conversely, victims of bullying who experienced one or more additional threats to physical safety were successively more likely to report these adverse outcomes. Notably, victims of school-bullying and VoCBs with all three additional risk factors were 13.13 and 17.75 times more likely to exhibit suicidality, respectively. Conclusion Risk of depression symptoms and suicidality among victims of school-bullying and/or cyber-bullying is greatly increased among those who have experienced additional threats to physical safety: fighting at school, being threatened/injured at school and skipping school out of fear for their safety.

Background Lack of sleep and on going sleep disorder can affect family health and interpersonal relationships. Objective The aim of study was to investigate the association between sleep quality and the probable determinants of quality of life among students of a public health faculty at Shahid Beheshti University of Medical Sciences (SBMU) in the 2015 academic year. Methods The data from a cross-sectional study of 275 students that randomly stratified sampling between different classes of college students of a public health faculty of Shahid Beheshti University of Medical Sciences were used in this study. The data were collected using a structured questionnaire consisted of modules on socio-demographic characteristics, the Petersburg Standardized Sleep Quality Questionnaire(PSQL) and the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF). Data analysis was done with descriptive and logistic regression. All analyses were carried out using SPSS software V.19. Results A total of 275 students participated in this study. The mean age ± standard deviation (SD) was 22.1 ± 3.6 years. In the univariable model, students that were living in their own homes had the odds of 2.18 times more than the others to have a higher quality of life level [95% confidence interval (CI): 1.07–4.45]. Moreover, sleep disorder was negatively associated with the quality of life [odds ratio (OR) = 0.23; 95% CI: 0.12–0.46]. Conclusion These results will help university administrators and policy makers to identify factors associated with poor sleep and provide approaches to enhance sleep hygiene and relevant knowledge in university students. Living in a dormitoy while also suffering from sleep problems could significantly reduce the quality of life.

Objective Female adolescent athletes seem to use oral contraceptives (OCs) in the same proportion as the general population. In athletes not using OCs, menstrual irregularity (MI) is reported to be common but there are few studies of MI in adolescent athletes. The aim of the study was to survey menarche, menstrual irregularity and use of OCs in adolescent athletes in the National Sports High Schools in Sweden. A further aim was to study the associations between current sport injury and menstrual irregularity as well as use of OCs. Subjects Two hundred and ninety-eight female adolescent athletes at Swedish National Sports High Schools. Methods A web-based questionnaire containing questions related to menstrual status, contraception and current injury. Results One third (32.6%) of the athletes used OCs and of the remaining athletes 31.8% had MI. The group of athletes with MI had a significantly (p = 0.038; Cohen’s d, 0.32) lower BMI and consisted of a significantly (p = 0.043) higher proportion of endurance athletes. OC users were less likely to participate in endurance sports compared to non-OC users (p = 0.024). Current injury was equally distributed in the OC and the non-OC group but athletes with MI had fewer sports injuries compared to eumenorrheic women. Conclusion OCs are frequently used among athletes at Swedish National Sports High Schools. OC users were less likely to participate in endurance sports compared to non-OC users. MI was common and athletes with MI had lower BMI compared to eumenorrheic athletes. Sports injuries were not associated with use of OC and eumenorrheic athletes had a higher proportion of current injury.

Background Currently, it is estimated that 40% of the Iranian population is less than 20 years old, and in the academic year of 2011–2012 about 4 million students of that age were educated. The general assessment of the outcomes of oral health programs and investigating determinants is substantial for developing future plans of oral health. This study was done with the aim of exploring brushing behavior among university students of Iran to specify and understand the important determinants of oral health behavior. Methods A qualitative research method was used. This study was conducted between August and November 2016 in Shahid Beheshti University. Maximum variation sampling was used among university attendees and 44 students with more than 2 years of study duration were selected to be included in the research. Semi-structured interviews were employed for data gathering. All of the recorded interviews and notes were accurately evaluated and data analysis was performed based on the content analysis. Results As a result of the interview analysis 16 main categories emerged: Religious Beliefs, Perceived Benefits, Perceived Barriers, Habitation, Salience of Behavior, Education, Subjective Norms, Peer Pressure, Observational Learning, Knowledge, Perceived Susceptibility, Perceived Severity, Outcome Expectation, Skills, Perceived Self-efficacy, and Perceived Behavioral Control. Codes of sub-theme and theme were identified in the study. Conclusion This present study provides additional evidence with respect to the religious beliefs and the impact of religious instructions in brushing among students. Salience of brushing behavior has been described as one of the structures in an integrated behavioral model. Despite earlier studies suggesting, that peer pressure only plays a role on children’s brushing behavior, our study showed that peer pressure is effective on adults as well.

Background Vigorous physical activity (VPA) may be beneficial for mental health. The aim of the study was to investigate cross-sectional associations between VPA, perceived stress, sleep quality and quantity and mental health among university students. Methods In a cross-sectional study, using anonymous questionnaires, data was collected from 15122 (42.1% male and 57.9% female) university students [mean age 20.6, standard deviation (SD) = 2.0] from 23 countries in the Americas, Africa and Asia. They were assessed using the International Physical Activity Questionnaire (short version), and measures of sociodemographic, health status, health behaviour and anthropometrics. Results Students who met VPA recommendations were less likely to report perceived stress, more likely to report subjective good health and depression than students without VPA. There was no association between VPA and sleep quality and quantity and PTSD symptoms. Conclusion This study only found partial benefits of VPA in relation to well-being of university students.

Background This study examines age-related changes in the quadriceps femoris (QF), subdivided into the vastus medialis oblique (VMO), vastus medialis (VM), rectus femoris (RF), vastus intermedius (VI) and vastus lateralis (VL) in basketball players. Subjects Seventy male basketball players were divided into four groups according to age (12–13, 14–15, 16–17, and 18–20 years). Methods Ultrasonography was used to measure muscle architecture of the VMO, VM, RF, VI and VL. We created cubic approximate expressions and calculated inflexion points to evaluate peak growth age of each muscle head. Results Significant interactions were observed for all QF parts (p < 0.01–0.001). Muscle thickness (MT) in all QF parts was significantly lower in 12–13-year olds than in 18–20-year olds (p < 0.01–0.001). Significant differences were recognised between 12–13 and 16–17-year olds in VM (p < 0.001), RF (p < 0.001) and VL (p = 0.007). MT was significantly lower in 14–15-year olds than in 16–17-year olds in the VM (p = 0.007) and RF (p = 0.026) and in 18–20 year olds in the VM (p < 0.001), RF (p = 0.036) and VI (p < 0.001). Peak growth age was estimated for each QF part (VMO, 155.0 months; VM, 187.8 months; RF, 212.2 months, VI, 188.9 months; VL, 181.1 months). Conclusion QF parts have different growth rates due to differing functions in each muscle head.

Background Childhood obesity has become a global public health crisis. Many studies have been conducted to explore the knowledge, attitude and practices towards eating and physical activity amongst parents and healthcare workers. However, very little is known amongst children. It is imperative to understand these factors as they have been associated with obesity among children. Objective This study aimed to assess the knowledge, attitude and practices of Bruneian children towards eating and physical activity, in order to identify the factors that influence the development of obesity. Methods The study involved 353 children from four primary schools in Brunei. The data collection tool used was modified validated questionnaires with sections on demographic characteristic, knowledge about obesity, eating habits and physical activity. Results The majority of children (>60%) had good knowledge of obesity and intake of healthy food, but, 84.2% lacked knowledge on the required daily servings of fruits and vegetables. 68.8% purchased food and beverages from their school canteen. 93.8% were aware about the health benefits of physical activity and 70.2% spent only 1–2 h of screen time per day, however, 46.9% did not meet the recommended amount of physical activity although they reported to have performed enough. This suggested that a comprehensive education on food intake requirements and physical activity are necessary in order to better educate children. Conclusion Health educators and public health professionals may find our findings useful in order to plan and develop tailored interventions for children, as well as better promotion of a healthy lifestyle to children and their families.