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Int. J. Environ. Res. Public Health 2013, 10(7), 2944-2978; doi:10.3390/ijerph10072944
Article

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

1,* , 2,†
, 3,†
 and 2,†
Received: 22 May 2013; in revised form: 4 July 2013 / Accepted: 5 July 2013 / Published: 16 July 2013
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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 psychosocial determinants; health behavior; objective health; health complaints; subjective health
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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MDPI and ACS Style

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.

AMA Style

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.

Chicago/Turabian Style

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.



Int. J. Environ. Res. Public Health EISSN 1660-4601 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert