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Distal and Proximal Factors of Health Behaviors and Their Associations with Health in Children and Adolescents
Technische Universität München, Georg-Brauchle-Ring 60/62, München 80992, Germany
Karlsruhe Institute of Technology, Engler-Bunte-Ring 15 Geb. 40.40, Karlsruhe 76131, Germany
Robert Koch Institute Berlin, Postfach 650261, Berlin 13302, Germany
These authors contributed equally to this work.
* Author to whom correspondence should be addressed.
Received: 22 May 2013; in revised form: 4 July 2013 / Accepted: 5 July 2013 / Published: 16 July 2013
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.
Keywords: psychosocial determinants; health behavior; objective health; health complaints; subjective health
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Lämmle, L.; Woll, A.; Mensink, G.B.M.; Bös, K. Distal and Proximal Factors of Health Behaviors and Their Associations with Health in Children and Adolescents. Int. J. Environ. Res. Public Health 2013, 10, 2944-2978.
Lämmle L, Woll A, Mensink GBM, Bös K. Distal and Proximal Factors of Health Behaviors and Their Associations with Health in Children and Adolescents. International Journal of Environmental Research and Public Health. 2013; 10(7):2944-2978.
Lämmle, Lena; Woll, Alexander; Mensink, Gert B.M.; Bös, Klaus. 2013. "Distal and Proximal Factors of Health Behaviors and Their Associations with Health in Children and Adolescents." Int. J. Environ. Res. Public Health 10, no. 7: 2944-2978.