Do Crowding-Out Effects Explain the Low Effect of a Health Promotion Intervention among Young People at a Vocational School?
Abstract
:1. Introduction
Conceptual Foundation
2. Materials and Methods
2.1. Procedures
2.2. Instruments
2.3. Data Analyses
2.3.1. Dependent Variables—Internal and External Symbolic Violence
2.3.2. Independent Variable—Student Types
2.3.3. Subgroup Analyses—Stigmatized and Non-Stigmatized Behavior
2.3.4. Heterogeneous Effect
2.4. Ethical Considerations
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Outcome | Description | Outcome Range | Mean (SD) |
---|---|---|---|
Physical and mental health | Cronbach’s alpha = 0.840 | 0–27 | 7615 (5678) |
Headache | Dummy variable = 1 if the student had pain at least once a week, zero otherwise | 0–1 | 0.236 (0.428) |
Stomach pain | Dummy variable = 1 if the student had pain at least once a week, zero otherwise | 0–1 | 0.145 (0.355) |
Back pain | Dummy variable = 1 if the student had pain at least once a week, zero otherwise | 0–1 | 0.290 (0.458) |
Sad | Dummy variable = 1 if the student felt sad at least once a week, zero otherwise | 0–1 | 0.090 (0.290) |
Irritable | Dummy variable = 1 if the student felt irritable at least once a week, zero otherwise | 0–1 | 0.400 (0.490) |
Bad mood | Dummy variable = 1 if the student was in a bad mood at least once a week, zero otherwise | 0–1 | 0.290 (0.458) |
Nervous | Dummy variable = 1 if the student was nervous at least once a week, zero otherwise | 0–1 | 0.200 (0.403) |
Sleeping problems | Dummy variable = 1 if the student had sleeping problems at least once a week, zero otherwise | 0–1 | 0.436 (0.500) |
Dizzy | Dummy variable = 1 if the student felt dizzy at least once a week, zero otherwise | 0–1 | 0.072 (0.262) |
Outcome | Description | Outcome Range | Mean (SD) |
---|---|---|---|
Need to change habits | Cronbach’s alpha = 0.651 | ||
Eating | The possible answers were very bad, bad, decent, good, and very good | 1–4 | 0.400 (0.494) |
Exercise | The possible answers were very bad, bad, decent, good, and very good | 1–4 | 0.309 (0.466) |
Nice to change habits | Cronbach’s alpha = 0.756 | ||
Eating | Dummy variable = 1 if the student replied yes, 0 otherwise | 0–1 | 0.290 (0.458) |
Exercise | Dummy variable = 1 if the student replied yes, 0 otherwise | 0–1 | 0.2902 (0.4583) |
Outcome | Description | Outcome Range | Mean (SD) |
---|---|---|---|
Stigmatizing behavior | |||
In-school physical activity | Standardized continuous index of intensity and frequency of physical activity level based on 3 items (each measured on a 6-point scale and gradually increased as an exponential function) | 0–1 (0–18) | 0.5722 (0.3277) |
Out-of-school physical activity | Standardized continuous index of intensity and frequency of physical activity level based on 2 items (each measured in hours and minutes and gradually increased as an exponential function) | 0–1 | 0.5722 (0.3277) |
In-school unhealthy food consumption | Standardized continuous index (derived from 7 items, each measured on a 4-point scale) that determined whether the students had healthy eating habits | 0–1 (0–42) | 0.4872 (0.1114) |
Non-stigmatizing behavior | |||
In-school seated activity | Standardized continuous index of the frequency of seated activity level in school (measured in hours and minutes) | 0–1 | 0.5722 (0.3277) |
Out-of-school seated activity | Standardized continuous index of seated activity level out of school (derived from 2 items, measured on an 8-point scale) | 0–1 (0–16) | 0.5722 (0.3277) |
Out-of-school sleep activity | Standardized continuous index of frequency of sleep out of school (measured in hours and minutes) | 0–1 | 0.5722 (0.3277) |
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Mean | (SD) | |
---|---|---|
Gender | ||
Male | 0.9325 | (0.2495) |
Age | ||
15–19 years | 0.7051 | (0.4589) |
20–24 years | 0.1923 | (0.3966) |
25–29 years | 0.0512 | (0.2220) |
≥30 years | 0.0128 | (0.1132) |
Educational program | ||
Auto mechanic | 0.7368 | (0.4432) |
Behavior Type | Characteristic | Example |
---|---|---|
Compensating | Behave healthily in school, but unhealthily out of school. | When increasing PE in school students may compensate by consuming more on healthy food in school, spending more time on seated activities, and being less physically active out of school. |
Contradictive | Behave unhealthily in school, but healthily out of school. | Students may be acting counterintuitively by being more in active in school, but at the same time spend less time on seated activities, and being more physically active out of school. |
Neclecting | Behave unhealthily both in and out of school. | Students may be ignoring the intervention by being less active and consume unhealthy food in school, and at the same time, spend more time on seated activities and being less physically active out of school. |
Elite | Behave healthily both in and out of school. | By being more active and consuming less unhealthy food in school, and at the same time, spend less time on seated activities and being more physically active out of school. |
Constraints | Stigma | Description |
---|---|---|
In-school and out-of-school physical activity trade-off | Stigmatizing | In-school physical activity was a dummy variable = 1 if the students scored above the 50th percentile of this variable, 0 otherwise Out-of-school physical activity was a dummy variable = 1 if the students scored above the 50th percentile of this variable, 0 otherwise |
Non-stigmatizing | In-school seated activity was a dummy variable = 1 if the students scored above the 50th percentile of this variable, 0 otherwise Out-of-school seated activity was a dummy variable = 1 if the students scored above the 50th percentile of this variable, 0 otherwise | |
In-school and out-of-school food consumption trade-off | Stigmatizing | In-school unhealthy food was a dummy variable = 1 if the students scored above the 50th percentile of this variable, 0 otherwise Out-of-school unhealthy was a dummy variable = 1 if the students scored above the 50th percentile of this variable, 0 otherwise |
Non-stigmatizing | In-school healthy food was a dummy variable = 1 if the students scored above the 50th percentile of this variable, 0 otherwise Out-of-school healthy was a dummy variable = 1 if the students scored above the 50th percentile of this variable, 0 otherwise | |
Energy constraint | Stigmatizing | In-school physical activity was a dummy variable = 1 if the students scored about the 50th percentile of this variable, 0 otherwise In-school unhealthy food consumption was one dummy variable = 1 if the students scored above the 50th percentile of this variable, 0 otherwise |
Non-stigmatizing | In-school physical activity was a dummy variable = 1 if the students scored above the 50th percentile of this variable, 0 otherwise Out-of-school seated activity was a dummy variable = 1 if the students scored above the 50th percentile of this variable, 0 otherwise | |
Time constraint | Stigmatizing | Out-of-school physical activity was a dummy variable = 1 if the students scored above the 50th percentile of this variable, 0 otherwise Out-of-school seated activity was a dummy variable = 1 if the students scored above the 50th percentile of this variable, 0 otherwise |
Non-stigmatizing | Out-of-school physical activity was a dummy variable = 1 if the students scored above the 50th percentile of this variable, 0 otherwise Out-of-school sleeping activity was a dummy variable = 1 if the students scored above the 50th percentile of this variable, 0 otherwise |
Stigma | Non-Stigma | Stigma | Non-Stigma | |||||
---|---|---|---|---|---|---|---|---|
ESV | Not ESV | ESV | Not ESV | ISV | Not ISV | ISV | Not ISV | |
N | 34 | 21 | 34 | 21 | 36 | 19 | 36 | 19 |
A. In-school and out-of-school physical activity | ||||||||
Compensating | 0.264 (0.447) | 0.428 (0.507) | 0.235 (0.430) | 0.285 (0.462) | 0.472 (0.506) | 0.052 *** (0.229) | 0.222 (0.421) | 0.315 ** (0.477) |
Contradictive | 0.205 (0.410) | 0.095 (0.300) | 0.235 (0.430) | 0.380 (0.497) | 0.138 (0.350) | 0.210 (0.418) | 0.305 (0.467) | 0.263 (0.452) |
Neglecting | 0.294 (0.462) | 0.142 (0.358) | 0.294 (0.462) | 0.095 * (0.300) | 0.166 (0.377) | 0.368 * (0.495) | 0.166 (0.377) | 0.315 (0.477) |
Elite | 0.235 (0.430) | 0.333 (0.483) | 0.235 (0.430) | 0.238 (0.436) | 0.222 (0.421) | 0.368 (0.495) | 0.305 (0.467) | 0.105 * (0.315) |
B. In-school and out-of-school food consumption | ||||||||
Compensating | 0.058 (0.238) | 0.285 ** (0.462) | 0.088 (0.287) | 0.285 ** (0.462) | 0.138 (0.350) | 0.157 (0.374) | 0.166 (0.377) | 0.157 (0.374) |
Contradictive | 0.470 (0.506) | 0.285 (0.462) | 0.529 (0.506) | 0.380 (0.497) | 0.388 (0.494) | 0.421 (0.4507) | 0.472 (0.506) | 0.473 (0.512) |
Neglecting | 0 | 0 | 0.382 (0.493) | 0.333 (0.483) | 0 | 0 | 0.361 (0.487) | 0.368 (0.495) |
Elite | 0.470 (0.506) | 0.428 (0.507) | 0 | 0 | 0.472 (0.506) | 0.421 (0.507) | 0 | 0 |
Stigma | Non-Stigma | |||
---|---|---|---|---|
ESV | ISV | ESV | ISV | |
A. In-school and out-of-school physical activity | ||||
Compensating | 2433 (2219) | 1620 *** (0.661) | −1266 (2.625) | −0.069 (0.877) |
Contradictive | 2100 (3215) | −1679 ** (0.861) | −0.743 (2478) | −0.300 (0.863) |
Neglecting | 6100 *** (2431) | −1300 * (0.715) | 2904 (2879) | −1925 ** (0.989) |
B. In-school and out-of-school food consumption | ||||
Compensating | −5292 ** (2402) | −0.311 (0.933) | −3166 (2600) | 0 |
Contradictive | −1900 (1997) | −1022 (0.690) | −0.311 (2100) | −0.220 (0.903) |
Neglecting | 0 | 0 | 0 | −0.500 (0.941) |
Stigma | Non-Stigma | |||
---|---|---|---|---|
ESV | ISV | ESV | ISV | |
Panel A. Energy constraint | ||||
Compensating | −2955 (2950) | −0.600 (0.961) | 2333 (3304) | −1178 (0.990) |
Contradictive | 4717 ** (2377) | 1400 (0.935) | 4318 * (2615) | 1068 (0.869) |
Neglecting | 0.301 (2259) | 0.150 (0.843) | 4285 * (2494) | 0.500 (0.806) |
Panel B. Time constraint | ||||
Compensating | −1233 (2283) | 0.375 (0.706) | 4789 ** (2394) | −0.060 (0.862) |
Contradictive | 2200 (2501) | −2400 *** (0.792) | 2989 (1997) | −2342 *** (0.655) |
Neglecting | 4150 (3309) | −1642 * (0.880) | 8789 *** (2812) | −2227 ** (1017) |
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Mikkelsen, B.E.; Romani, A.Q.; Brandão, M.P. Do Crowding-Out Effects Explain the Low Effect of a Health Promotion Intervention among Young People at a Vocational School? Int. J. Environ. Res. Public Health 2021, 18, 11127. https://doi.org/10.3390/ijerph182111127
Mikkelsen BE, Romani AQ, Brandão MP. Do Crowding-Out Effects Explain the Low Effect of a Health Promotion Intervention among Young People at a Vocational School? International Journal of Environmental Research and Public Health. 2021; 18(21):11127. https://doi.org/10.3390/ijerph182111127
Chicago/Turabian StyleMikkelsen, Bent E., Annette Q. Romani, and Maria P. Brandão. 2021. "Do Crowding-Out Effects Explain the Low Effect of a Health Promotion Intervention among Young People at a Vocational School?" International Journal of Environmental Research and Public Health 18, no. 21: 11127. https://doi.org/10.3390/ijerph182111127