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Distal and Proximal Factors of Health Behaviors and Their Associations with Health in Children and Adolescents

Author

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  • Lena Lämmle

    (Technische Universität München, Georg-Brauchle-Ring 60/62, München 80992, Germany)

  • Alexander Woll

    (Karlsruhe Institute of Technology, Engler-Bunte-Ring 15 Geb. 40.40, Karlsruhe 76131, Germany
    These authors contributed equally to this work.)

  • Gert B. M. Mensink

    (Robert Koch Institute Berlin, Postfach 650261, Berlin 13302, Germany
    These authors contributed equally to this work.)

  • Klaus Bös

    (Karlsruhe Institute of Technology, Engler-Bunte-Ring 15 Geb. 40.40, Karlsruhe 76131, Germany
    These authors contributed equally to this work.)

Abstract

Objective : The aim of the present paper was to analyze factors affecting distal and proximal health behavior within a biopsychosocial model for examining their interactions and associations with respect to health. Methods : Path analysis was based on the nationwide, cross-sectional German Health Interview and Examination Survey for Children and Adolescents (2003 to 2006). The data was collected from 4,529 participants with an average age of 9.45 years ( SD = 4.01). Socio-demographic data, psychosocial factors and health behavior were assessed via questionnaire. Participants also underwent physical fitness tests and a medical examination. Results : Over the five levels of the model analyzed with socioeconomic status, immigration background, and rural-urban differences on the first level; physical activity of relatives and peers, intrinsic motivation, and quality of life on the second level; eating patterns, sedentary behavior, and physical activity on the third level; physical fitness and objective health on the fourth level; and health complaints and subjective health on the fifth level; direct, moderation, and mediation effects could be shown. Conclusions : Several distal and proximal factors are needed to take account of the multivariate complexity of health: e.g., immigration background affected health behaviors only indirectly and the effect of physical activity on objective health was mediated by physical fitness.

Suggested Citation

  • Lena Lämmle & Alexander Woll & Gert B. M. Mensink & Klaus Bös, 2013. "Distal and Proximal Factors of Health Behaviors and Their Associations with Health in Children and Adolescents," IJERPH, MDPI, vol. 10(7), pages 1-35, July.
    • Handle: RePEc:gam:jijerp:v:10:y:2013:i:7:p:2944-2978:d:27230
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