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Health-related quality of life in adolescents: individual and combined impact of health-related behaviors (DADOS study)

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Abstract

Purpose

To investigate the individual and combined effect of physical activity, adherence to the Mediterranean diet, sleep quality, sleep duration, and screen time on health-related quality of life (HRQoL) in adolescents.

Methods

This is a cross-sectional analysis with 262 adolescents (13.9 ± 0.3 years) from DADOS (Deporte, ADOlescencia y Salud) study. Physical activity was assessed with a wrist-worn GENEActiv triaxial accelerometer. Adherence to the Mediterranean diet was evaluated by the KIDMED questionnaire. Sleep patterns were self-reported through the Spanish version of Pittsburgh Sleep Quality Index questionnaire. Screen time was assessed through the HELENA sedentary behavior questionnaire. HRQoL was measured using the KIDSCREEN-10 questionnaire. Scores were categorized into low and high using a normative cut-off used to identify factors associated with being in a high HRQoL group. A healthy lifestyle index was created including positive scores for each individual behavior, and five categories of achievement were established (0, 1, 2, 3, ≥ 4).

Results

Sleep patterns and screen time revealed a significant individual relationship with HRQoL (p < 0.05). Adolescents achieving ≥ 3 positive health-related behaviors showed higher HRQoL levels compared to those fulfilling none (p < 0.05). Logistic regression analysis revealed an increased likelihood of high HRQoL according to the number of positive health-related behaviors achieved (p < 0.05).

Conclusions

Our results reveal higher levels of HRQoL in those adolescents achieving ≥ 3 health-related behaviors compared to their peers achieving none. Moreover, our findings show a cumulative effect of health-related behaviors on HRQoL. These findings underline the key role of promoting a healthy lifestyle in order to improve adolescents’ health and well-being.

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References

  1. Hays, R., & Reeve, B. (2010). Measurement and modeling of health-related quality of life. In J. Z. J. Killewo, K. Heggenhougen, & S. R. Quah (Eds.), Epidemiology and demography in Public Health. Cambridge: Academic Press.

    Google Scholar 

  2. Ravens-Sieberer, U., Gosh, A., Erhart, M., von Rueden, U., Nickel, J., & Kurth, B.-M. (2006). The KIDSCREEN questionnaires: Quality of life questionnaires for children and adolescents. Lengerich: Handbook.

    Google Scholar 

  3. Costarelli, V., Koretsi, E., & Georgitsogianni, E. (2013). Health-related quality of life of Greek adolescents: the role of the Mediterranean diet. Quality of Life Research, 22(5), 951–956.

    Article  CAS  Google Scholar 

  4. de Matos, M. G., Marques, A., Gaspar, T., & Paiva, T. (2017). Perception of quantity and quality of sleep and their association with health related quality of life and life satisfaction during adolescence. Health Education and Care, 2(2), 1–6.

    Google Scholar 

  5. Gopinath, B., Hardy, L. L., Baur, L. A., Burlutsky, G., & Mitchell, P. (2012). Physical activity and sedentary behaviors and health-related quality of life in adolescents. Pediatrics, 130(1), e167–e174.

    Article  Google Scholar 

  6. Mireku, M. O., Barker, M. M., Mutz, J., Dumontheil, I., Thomas, M. S. C., Röösli, M., … Toledano, M. B. (2019). Night-time Screen-Based Media Device Use and Adolescents’ Sleep and Health-Related Quality of Life. Environment International, 124, 66–78

  7. Roeser, K., Eichholz, R., Schwerdtle, B., Schlarb, A. A., & Kübler, A. (2012). Relationship of sleep quality and health-related quality of life in adolescents according to self- and proxy ratings: A questionnaire survey. Frontiers in Psychiatry, 3(9), 76.

    PubMed  PubMed Central  Google Scholar 

  8. Wu, X. Y., Han, L. H., Zhang, J. H., Luo, S., Hu, J. W., & Sun, K. (2017). The influence of physical activity, sedentary behavior on health-related quality of life among the general population of children and adolescents: A systematic review. Quality of Life Research, 28(8), 1989–2015.

    Article  Google Scholar 

  9. Burdette, A. M., Needham, B. L., Taylor, M. G., & Hill, T. D. (2017). Health lifestyles in adolescence and self-rated health into adulthood. Journal of Health and Social Behavior, 58(4), 520–536.

    Article  Google Scholar 

  10. Pronk, N. P., Anderson, L. H., Crain, A. L., Martinson, B. C., O’Connor, P. J., Sherwood, N. E., & Whitebird, R. R. (2004). Meeting recommendations for multiple healthy lifestyle factors: Prevalence, clustering, and predictors among adolescent, adult, and senior health plan members. American Journal of Preventive Medicine, 27, 25–33.

    Article  Google Scholar 

  11. Atallah, N., Adjibade, M., Lelong, H., Hercberg, S., Galan, P., Assmann, K. E., & Kesse-Guyot, E. (2018). How healthy lifestyle factors at midlife relate to healthy aging. Nutrients, 10(7), 20.

    Article  Google Scholar 

  12. Veronese, N., Li, Y., Manson, J. E., Willett, W. C., Fontana, L., & Hu, F. B. (2016). Combined associations of body weight and lifestyle factors with all cause and cause specific mortality in men and women: Prospective cohort study. BMJ (Online), 355, 854.

    Google Scholar 

  13. May, A. M., Romaguera, D., Travier, N., Ekelund, U., Bergmann, M. M., Kaaks, R., … Peeters, P. H. M. (2012). Combined Impact of Lifestyle Factors on Prospective Change in Body Weight and Waist Circumference in Participants of the EPIC-PANACEA Study. PLoS ONE, 7(11), e50712.

  14. Marques, A., Peralta, M., Santos, T., Martins, J., & Gaspar de Matos, M. (2019). Self-rated health and health-related quality of life are related with adolescents’ healthy lifestyle. Public Health, 170, 89–94.

    Article  CAS  Google Scholar 

  15. Esliger, D. W., Rowlands, A. V., Hurst, T. L., Catt, M., Murray, P., & Eston, R. G. (2011). Validation of the GENEA accelerometer. Medicine and Science in Sports and Exercise, 43(6), 1085–1093.

    Article  Google Scholar 

  16. Phillips, L. R. S., Parfitt, G., & Rowlands, A. V. (2013). Calibration of the GENEA accelerometer for assessment of physical activity intensity in children. Journal of Science and Medicine in Sport, 16(2), 124–128.

    Article  Google Scholar 

  17. Hrafnkelsdottir, S. M., Brychta, R. J., Rognvaldsdottir, V., Gestsdottir, S., Chen, K. Y., Johannsson, E., … Arngrimsson, S. A. (2018). Less screen time and more frequent vigorous physical activity is associated with lower risk of reporting negative mental health symptoms among Icelandic adolescents. PLoS ONE, 13(4), e0196286

  18. Tarp, J., Child, A., White, T., Westgate, K., Bugge, A., Grøntved, A., … Brage, S. (2018). Physical activity intensity, bout-duration, and cardiometabolic risk markers in children and adolescents. International Journal of Obesity, 42(9), 1639–1650.

  19. Serra-Majem, L., Ribas, L., Ngo, J., Ortega, R. M., García, A., Pérez-Rodrigo, C., & Aranceta, J. (2004). Food, youth and the Mediterranean diet in Spain: development of KIDMED, Mediterranean diet quality index in children and adolescents. Public Health Nutrition, 7(7), 931–935.

    Article  Google Scholar 

  20. Royuela Rico, A., & Macías Fernández, J. (1997). Propiedades clinimetricas de la versión castellana del cuestionario de Pittsburgh. Vigilia-Sueño, 9, 81–94.

    Google Scholar 

  21. Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193–213.

    Article  CAS  Google Scholar 

  22. Grandner, M. A., Kripke, D. F., Yoon, I. Y., & Youngstedt, S. D. (2006). Criterion validity of the Pittsburgh sleep quality index: Investigation in a non-clinical sample. Sleep and Biological Rhythms, 4(2), 129–136.

    Article  Google Scholar 

  23. de la Vega, R., Tomé-Pires, C., Solé, E., Racine, M., Castarlenas, E., Jensen, M. P., & Miró, J. (2015). The Pittsburgh sleep quality index: Validity and factor structure in young people. Psychological Assessment, 27(4), e22–e27.

    Article  Google Scholar 

  24. Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., … Adams Hillard, P. J. (2015). National sleep foundation’s sleep time duration recommendations: Methodology and results summary. Sleep Health, 1(1), 40–43

  25. Rey-López, J. P., Vicente-Rodriguez, G., Ortega, F. B., Ruiz, J. R., Martinez-Gómez, D., De Henauw, S., … Moreno, L. A. (2010). Sedentary patterns and media availability in European adolescents: The HELENA study. Preventive Medicine, 51(1), 50–55

  26. Ravens-Sieberer, U., Erhart, M., Rajmil, L., Herdman, M., Auquier, P., Bruil, J., … Kilroe, J. (2010). Reliability, construct and criterion validity of the KIDSCREEN-10 score: A short measure for children and adolescents’ well-being and health-related quality of life. Quality of Life Research, 19(10), 1487–1500

  27. Pogodina, A., Rychkova, L., Kravtzova, O., Klimkina, J., & Kosovtzeva, A. (2017). Cardiometabolic risk factors and health-related quality of life in adolescents with obesity. Childhood Obesity, 13(6), 499–506.

    Article  Google Scholar 

  28. Svedberg, P., Nygren, J. M., Staland-Nyman, C., & Nyholm, M. (2016). The validity of socioeconomic status measures among adolescents based on self-reported information about parents occupations, FAS and perceived SES; Implication for health related quality of life studies. BMC Medical Research Methodology, 16(1), 48.

    Article  CAS  Google Scholar 

  29. Tanner, J. M., & Whitehouse, R. H. (1976). Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty. Archives of Disease in Childhood, 51(3), 170–179.

    Article  CAS  Google Scholar 

  30. Chavarro, J. E., Watkins, D. J., Afeiche, M. C., Zhang, Z., Sánchez, B. N., Cantonwine, D., … Peterson, K. E. (2017). Validity of self-assessed sexual maturation against physician assessments and hormone levels. Journal of Pediatrics, 186, 172-178.e3

  31. Currie, C., Molcho, M., Boyce, W., Holstein, B., Torsheim, T., & Richter, M. (2008). Researching health inequalities in adolescents: The development of the Health Behaviour in School-Aged Children (HBSC) Family Affluence Scale. Social Science & Medicine, 66, 1429–1436.

    Article  Google Scholar 

  32. Field, A. (2005). Discovering statistics using SPSS statistics. London: Sage Publications Ltd.

    Google Scholar 

  33. Paiva, T., Gaspar, T., & Matos, M. G. (2015). Sleep deprivation in adolescents: Correlations with health complaints and health-related quality of life. Sleep Medicine, 16(4), 521–527.

    Article  Google Scholar 

  34. Moore, M., & Meltzer, L. J. (2008). The sleepy adolescent: Causes and consequences of sleepiness in teens. Paediatric Respiratory Reviews, 9(2), 114–121.

    Article  Google Scholar 

  35. Bruce, E. S., Lunt, L., & McDonagh, J. E. (2017). Sleep in adolescents and young adults. Clinical Medicine Journal of the Royal College of Physicians of London, 17(5), 424–4228.

    Google Scholar 

  36. Owens, J., Au, R., Carskadon, M., Millman, R., Wolfson, A., Braverman, P. K., … O’Brien, R. F. (2014). Insufficient sleep in adolescents and young adults: An update on causes and consequences. Pediatrics, 134(3), e921–e932

  37. Dewald, J. F., Meijer, A. M., Oort, F. J., Kerkhof, G. A., & Bögels, S. M. (2010). The influence of sleep quality, sleep duration and sleepiness on school performance in children and adolescents: A meta-analytic review. Sleep Medicine Reviews, 14(3), 179–189.

    Article  Google Scholar 

  38. Iannotti, R. J., Kogan, M. D., Janssen, I., & Boyce, W. F. (2009). Patterns of Adolescent Physical Activity, Screen-Based Media Use, and Positive and Negative Health Indicators in the U.S. and Canada. Journal of Adolescent Health, 44(5), 493–499.

    Article  Google Scholar 

  39. Lacy, K. E., Allender, S. E., Kremer, P. J., De Silva-Sanigorski, A. M., Millar, L. M., Moodie, M. L., … Swinburn, B. A. (2012). Screen time and physical activity behaviours are associated with health-related quality of life in Australian adolescents. Quality of Life Research, 21(6), 1085–1099

  40. Page, A. S., Cooper, A. R., Griew, P., & Jago, R. (2010). Children’s screen viewing is related to psychological difficulties irrespective of physical activity. Pediatrics, 126(5), 1011.

    Article  Google Scholar 

  41. Muñoz, M. A., Fíto, M., Marrugat, J., Covas, M. I., & Schröder, H. (2009). Adherence to the Mediterranean diet is associated with better mental and physical health. British Journal of Nutrition, 101(12), 1821–1827.

    Article  Google Scholar 

  42. Brand, S., Kalak, N., Gerber, M., Clough, P. J., Lemola, S., Sadeghi Bahmani, D., … Holsboer-Trachsler, E. (2017). During early to mid adolescence, moderate to vigorous physical activity is associated with restoring sleep, psychological functioning, mental toughness and male gender. Journal of Sports Sciences, 35(5), 426–434

  43. Prochaska, J. J., Spring, B., & Nigg, C. R. (2008). Multiple health behavior change research: An introduction and overview. Preventive Medicine, 46(3), 181–188.

    Article  Google Scholar 

  44. Viner, R. M., Ross, D., Hardy, R., Kuh, D., Power, C., Johnson, A., … Batty, G. D. (2015). Life course epidemiology: Recognising the importance of adolescence. Journal of Epidemiology and Community Health, 69(8), 719–720

  45. Albani, V., Butler, L. T., Traill, W. B., & Kennedy, O. B. (2018). Understanding fruit and vegetable consumption in children and adolescents. The contributions of affect, self-concept and habit strength. Appetite, 120, 398–408.

    Article  Google Scholar 

  46. Aura, A., Sormunen, M., & Tossavainen, K. (2016). The relation of socio-ecological factors to adolescents’ health-related behaviour: A literature review. Health Education, 116(2), 177–201.

    Article  Google Scholar 

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Funding

The DADOS Study is funded by the Spanish Ministry of Economy and Competitiveness, MINECO (DEP2013–45515-R) and by the Jaume I University of Castellon, UJI (P1-1A2015-05 and UJI-A2019-12).

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Authors and Affiliations

  1. LIFE Research Group, University Jaume I, Av. de Vicent Sos Baynat, s/n, 12071, Castellon, Spain

    Alba Solera-Sanchez, Mireia Adelantado-Renau, Diego Moliner-Urdiales & Maria Reyes Beltran-Valls

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  1. Alba Solera-Sanchez
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  2. Mireia Adelantado-Renau
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  3. Diego Moliner-Urdiales
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  4. Maria Reyes Beltran-Valls
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by ASS, MAR, DMU, and MRBV. The first draft of the manuscript was written by ASS and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Maria Reyes Beltran-Valls.

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Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was performed in line with the ethical guidelines of the Declaration of Helsinki 1964 (last revision of Fortaleza, Brazil, 2013) and approved by the Research Ethics Committee of the University Jaume I of Castellon (Spain).

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Adolescents and their parents or guardians were informed of the nature and characteristics of the study, and all provided a written informed consent.

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Solera-Sanchez, A., Adelantado-Renau, M., Moliner-Urdiales, D. et al. Health-related quality of life in adolescents: individual and combined impact of health-related behaviors (DADOS study). Qual Life Res 30, 1093–1101 (2021). https://doi.org/10.1007/s11136-020-02699-9

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