Do School-Level Factors Affect the Health Behaviors of High School Students in Korea?
Abstract
:1. Introduction
2. Method
2.1. Study Population
2.2. Dependent Variables
2.3. Individual-Level Variables
2.4. School-Level Variables
2.5. Statistical Analysis
3. Results
3.1. Health Behaviors according to the Students’ General Characteristics
3.2. Individual-Level Factors Affecting Students’ Health Behaviors
3.3. School-Level Factors Affecting Students’ Health Behaviors
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | Total | Tooth Brushing Less than Twice a Day | p-Value | Soda Intake More than Three Times a Week | p-Value | Current Smoking | p-Value | High-Intensity Physical Activity Less than Two Days a Week | p-Value | |
---|---|---|---|---|---|---|---|---|---|---|
N (wt%) | N (wt%) | N (wt%) | N (wt%) | N (wt%) | ||||||
Total | 27,919 (100.0) | 12,859 (46.4) | 10,376 (37.4) | 2774 (9.9) | 20,655 (73.9) | |||||
Demographic factors | Sex | |||||||||
Boy | 14,440 (52.5) | 7642 (53.1) | <0.001 | 6581 (45.9) | <0.001 | 2041 (14.2) | <0.001 | 8889 (61.6) | <0.001 | |
Girl | 13,479 (47.8) | 5217 (39.0) | 3795 (28.2) | 733 (5.2) | 11,766 (87.2) | |||||
Grade | ||||||||||
1st | 9273 (32.9) | 4473 (49.1) | <0.001 | 3380 (36.7) | 0.235 | 728 (8.3) | <0.001 | 6803 (73.3) | <0.001 | |
2nd | 9044 (31.6) | 4245 (47.1) | 3373 (38.0) | 926 (10.0) | 6625 (72.5) | |||||
3rd | 9602 (35.6) | 4141 (43.2) | 3623 (37.6) | 1120 (11.4) | 7227 (75.6) | |||||
Socioeconomic factors | Self-reported economic status | |||||||||
Low | 4432 (15.4) | 2304 (52.4) | <0.001 | 1682 (38.3) | 0.448 | 589 (12.6) | <0.001 | 3293 (73.9) | <0.001 | |
Middle | 13,937 (50.0) | 6438 (46.4) | 5163 (37.3) | 1242 (9.1) | 10,528 (75.5) | |||||
High | 9550 (34.6) | 4117 (43.6) | 3531 (37.3) | 943 (9.9) | 6834 (71.5) | |||||
Academic performance | ||||||||||
Low | 10,012 (36.0) | 4990 (50.4) | <0.001 | 4107 (41.2) | < 0.001 | 1434 (14.3) | <0.001 | 7198 (71.8) | <0.001 | |
Middle | 8827 (31.7) | 3862 (43.8) | 3210 (36.8) | 695 (7.8) | 6656 (75.1) | |||||
High | 9080 (32.3) | 4007 (44.4) | 3059 (33.9) | 645 (7.1) | 6801 (74.9) | |||||
Health-related factors | Self-reported health status | |||||||||
Unhealthy | 9367 (33.5) | 4508 (48.4) | <0.001 | 3554 (38.3) | 0.035 | 904 (9.6) | 0.124 | 7918 (84.4) | <0.001 | |
Healthy | 18,552 (66.5) | 8353 (45.4) | 6822 (37.0) | 1870 (10.1) | 12,737 (68.6) | |||||
Self-reported oral health status | ||||||||||
Unhealthy | 19,599 (70.2) | 9714 (49.9) | <0.001 | 7534 (38.8) | < 0.001 | 1928 (9.8) | 0.468 | 14,837 (75.6) | <0.001 | |
Healthy | 8320 (29.8) | 3145 (38.0) | 2842 (34.3) | 846 (10.1) | 5818 (69.8) | |||||
Experience of stress | ||||||||||
Yes | 11,935 (42.4) | 5414 (45.7) | 0.062 | 4498 (38.0) | 0.103 | 1313 (11.1) | <0.001 | 9309 (78.0) | <0.001 | |
No | 15,984 (57.6) | 7445 (46.9) | 5878 (37.0) | 1461 (9.1) | 11,346 (70.8) | |||||
Experience of depression | ||||||||||
Yes | 8226 (29.4) | 3660 (44.9) | 0.001 | 3217 (31.1) | <0.001 | 1149 (13.9) | <0.001 | 6167 (74.6) | 0.088 | |
No | 19,693 (70.6) | 9199 (47.0) | 7159 (36.5) | 1625 (8.3) | 14,488 (73.6) | |||||
Oral symptoms | ||||||||||
Yes | 16,984 (60.8) | 8211 (48.7) | <0.001 | 6402 (38.2) | 0.001 | 1701 (10.0) | 0.562 | 12,984 (76.4) | <0.001 | |
No | 10,935 (39.2) | 4648 (42.8) | 3974 (36.2) | 1073 (9.8) | 7671 (69.9) |
Variable | Tooth Brushing Less than Twice a Day | Soda Intake More than Three Times a Week | Current Smoking | High-Intensity Physical Activity Less than Two Days a Week | |||||
---|---|---|---|---|---|---|---|---|---|
OR (95%CI) | p | OR (95%CI) | p | OR (95%CI) | p | OR (95%CI) | p | ||
Demographic factors | Sex | ||||||||
Boy | 1.86 (1.71–2.03) | <0.001 | 2.29 (2.14–2.44) | <0.001 | 3.38 (2.91–3.92) | <0.001 | 0.26 (0.24–0.28) | <0.001 | |
Girl | 1.00 | 1.00 | 1.00 | 1.00 | |||||
Grade | |||||||||
1st | 1.31 (1.21–1.41) | <0.001 | 0.97 (0.91–1.03) | 0.264 | 0.70 (0.62–0.79) | <0.001 | 0.92 (0.84–1.00) | 0.046 | |
2nd | 1.18 (1.10–1.27) | <0.001 | 1.01 (0.95–1.08) | 0.705 | 0.86 (0.76–0.97) | 0.012 | 0.85 (0.78–0.93) | <0.001 | |
3rd | 1.00 | 1.00 | 1.00 | 1.00 | |||||
Socioeconomic factors | Self-reported economic status | ||||||||
Low | 1.27 (1.18–1.37) | <0.001 | 0.92 (0.85–0.99) | 0.025 | 1.00 (0.88–1.13) | 0.963 | 1.04 (0.95–1.13) | 0.454 | |
Middle | 1.06 (1.01–1.12) | 0.027 | 0.95 (0.90–1.01) | 0.098 | 0.85 (0.77–0.93) | 0.001 | 1.16 (1.09–1.24) | <0.001 | |
High | 1.00 | 1.00 | 1.00 | 1.00 | |||||
Academic performance | |||||||||
Low | 1.19 (1.12–1.27) | <0.001 | 1.39 (1.30–1.48) | <0.001 | 2.29 (2.06–2.55) | <0.001 | 0.75 (0.69–0.80) | <0.001 | |
Middle | 0.97 (0.91–1.03) | 0.318 | 1.19 (1.12–1.27) | <0.001 | 1.21 (1.07–1.36) | 0.002 | 0.91 (0.84–0.98) | 0.016 | |
High | 1.00 | 1.00 | 1.00 | 1.00 | |||||
Health-related factors | Self-reported health status | ||||||||
Unhealthy | - | - | - | - | - | - | 2.09 (1.94–2.25) | <0.001 | |
Healthy | - | - | - | 1.00 | |||||
Self-reported oral health status | |||||||||
Unhealthy | 1.59 (1.51–1.68) | <0.001 | 1.22 (1.15–1.29) | <0.001 | - | - | - | - | |
Healthy | 1.00 | 1.00 | - | - | |||||
Experience of stress | |||||||||
Yes | - | - | - | - | - | - | 1.01 (0.95–1.08) | 0.782 | |
No | - | - | - | 1.00 | |||||
Experience of depression | |||||||||
Yes | 0.93 (0.88–0.98) | 0.005 | 1.24 (1.17–1.31) | <0.001 | 2.01 (1.83–2.20) | <0.001 | - | - | |
No | 1.00 | 1.00 | 1.00 | - | |||||
Oral symptoms | |||||||||
Yes | 1.25 (1.19–1.30) | <0.001 | 1.12 (1.06–1.18) | <0.001 | - | - | 1.14 (1.08–1.20) | <0.001 | |
No | 1.00 | 1.00 | - | 1.00 |
Model Parameter | Model 1 Null Model | Model 2 Unconditional Slope Model | Model 3 Final Model | ||||
---|---|---|---|---|---|---|---|
OR (95%CI) | p | OR (95%CI) | p | OR (95%CI) | p | ||
Fixed effect | |||||||
Level 1 | Intercept γ00 | 0.87 (0.82–0.93) | <0.001 | 0.33 (0.29–0.37) | <0.001 | 0.26 (0.23–0.30) | <0.001 |
Sex (boy vs. girl) | 1.74 (1.60–1.88) | <0.001 | 1.72 (1.57–1.89) | <0.001 | |||
Grade (1st vs. 3rd) | 1.28 (1.19–1.37) | <0.001 | 1.28 (1.19–1.38) | <0.001 | |||
Grade (2nd vs. 3rd) | 1.17 (1.09–1.26) | <0.001 | 1.18 (1.10–1.26) | <0.001 | |||
Self-reported economic status (lower vs. upper) | 1.24 (1.15–1.33) | <0.001 | 1.22 (1.14–1.32) | <0.001 | |||
Self-reported economic status (middle vs. upper) | 1.10 (1.04–1.16) | <0.001 | 1.09 (1.03–1.15) | 0.003 | |||
Academic performance (lower vs. upper) | 1.19 (1.12–1.27) | <0.001 | 1.20 (1.13–1.28) | <0.001 | |||
Academic performance (middle vs. upper) | 1.00 (0.94–1.06) | 0.914 | 1.00 (0.94–1.07) | 0.985 | |||
Self-reported health status (unhealthy vs. healthy) | - | - | - | - | |||
Self-reported oral health status (unhealthy vs. healthy) | 1.52 (1.45–1.60) | <0.001 | 1.53 (1.45–1.61) | <0.001 | |||
Experience of stress (yes vs. no) | - | - | - | - | |||
Experience of depression (yes vs. no) | 0.93 (0.89–0.98) | 0.010 | 0.94 (0.89–0.99) | 0.015 | |||
Oral symptoms (yes vs. no) | 1.24 (1.19–1.30) | <0.001 | 1.25 (1.19–1.31) | <0.001 | |||
Level 2 | School system (vocational vs. general) | 1.63 (1.43–1.87) | <0.001 | ||||
School type (boys’ vs. co-ed) | 1.40 (1.26–1.56) | <0.001 | |||||
School type (girls’ vs. co-ed) | 1.22 (1.05–1.43) | 0.010 | |||||
Random effect | |||||||
School-level variance Tau | 0.35 | <0.001 | 0.29 | <0.001 | 0.23 | <0.001 | |
ICC | 0.10 | 0.08 | 0.07 | ||||
Deviance | 78,247.90 | 78,172.12 | 78,142.22 | ||||
Reliability | 0.844 | 0.813 | 0.778 |
Model Parameter | Model 1 Null Model | Model 2 Unconditional Slope Model | Model 3 Final Model | ||||
---|---|---|---|---|---|---|---|
OR (95%CI) | p | OR (95%CI) | p | OR (95%CI) | p | ||
Fixed effect | |||||||
Level 1 | Intercept γ00 | 0.60 (0.57–0.63) | <0.001 | 0.28 (0.25–0.31) | <0.001 | 0.20 (0.18–0.24) | <0.001 |
Sex (boy vs. girl) | 2.16 (2.02–2.30) | <0.001 | 2.06 (1.91–2.23) | <0.001 | |||
Grade (1st vs. 3rd) | 0.95 (0.89–1.02) | 0.171 | 0.95 (0.89–1.02) | 0.174 | |||
Grade (2nd vs. 3rd) | 0.99 (0.92–1.06) | 0.738 | 0.99 (0.92–1.06) | 0.741 | |||
Self-reported economic status (lower vs. upper) | 0.88 (0.81–0.95) | 0.002 | 0.86 (0.79–0.93) | <0.001 | |||
Self-reported economic status (middle vs. upper) | 0.93 (0.88–0.99) | 0.019 | 0.93 (0.88–0.98) | 0.011 | |||
Academic performance (lower vs. upper) | 1.37 (1.29–1.47) | <0.001 | 1.39 (1.30–1.48) | <0.001 | |||
Academic performance (middle vs. upper) | 1.18 (1.10–1.26) | <0.001 | 1.18 (1.11–1.26) | <0.001 | |||
Self-reported health status (unhealthy vs. healthy) | - | - | |||||
Self-reported oral health status (unhealthy vs. healthy) | 1.22 (1.15–1.29) | <0.001 | 1.22 (1.15–1.29) | <0.001 | |||
Experience of stress (yes vs. no) | - | - | - | ||||
Experience of depression (yes vs. no) | 1.21 (1.14–1.29) | <0.001 | 1.22 (1.15–1.29) | <0.001 | |||
Oral symptoms (yes vs. no) | 1.11 (1.05–1.17) | <0.001 | 1.11 (1.05–1.17) | <0.001 | |||
Level 2 | School system (vocational vs. general) | 1.33 (1.21–1.46) | <0.001 | ||||
School type (boys’ vs. co-ed) | 1.03 (0.95–1.13) | 0.479 | |||||
School type (girls’ vs. co-ed) | 0.88 (0.80–0.98) | 0.019 | |||||
Random effect | |||||||
Variance | 0.18 | <0.001 | 0.08 | <0.001 | 0.07 | <0.001 | |
ICC | 0.05 | 0.02 | 0.02 | ||||
Deviance | 78,038.54 | 77,955.32 | 77,963.66 | ||||
Reliability | 0.730 | 0.549 | 0.507 |
Model Parameter | Model 1 Null Model | Model 2 Unconditional Slope Model | Model 3 Final Model | ||||
---|---|---|---|---|---|---|---|
OR (95%CI) | p | OR (95%CI) | p | OR (95%CI) | p | ||
Fixed effect | |||||||
Level 1 | Intercept γ00 | 0.12 (0.11–0.13) | <0.001 | 0.04 (0.04–0.05) | <0.001 | 0.03 (0.03–0.04) | <0.001 |
Sex (boy vs. girl) | 2.91 (2.54–3.32) | <0.001 | 2.72 (2.33–3.18) | <0.001 | |||
Grade (1st vs. 3rd) | 0.64 (0.57–0.72) | <0.001 | 0.63 (0.56–0.71) | <0.001 | |||
Grade (2nd vs. 3rd) | 0.86 (0.77–0.97) | 0.010 | 0.86 (0.76–0.96) | 0.009 | |||
Self-reported economic status (lower vs. upper) | 0.90 (0.80–1.01) | 0.064 | 0.86 (0.77–0.97) | 0.014 | |||
Self-reported economic status (middle vs. upper) | 0.77 (0.71–0.84) | <0.001 | 0.76 (0.69–0.83) | <0.001 | |||
Academic performance (lower vs. upper) | 2.22 (1.99–2.47) | <0.001 | 2.32 (2.07–2.59) | <0.001 | |||
Academic performance (middle vs. upper) | 1.25 (1.13–1.40) | <0.001 | 1.29 (1.15–1.44) | <0.001 | |||
Self-reported health status (unhealthy vs. healthy) | - | - | - | - | |||
Self-reported oral health status (unhealthy vs. healthy) | - | - | - | - | |||
Experience of stress (yes vs. no) | - | - | - | - | |||
Experience of depression (yes vs. no) | 2.01 (1.84–2.19) | <0.001 | 2.06 (1.88–2.26) | <0.001 | |||
Oral symptoms (yes vs. no) | - | - | - | - | |||
Level 2 | School system (vocational vs. general) | 2.89 (2.48–3.38) | <0.001 | ||||
School type (boys’ vs. co-ed) | 0.98 (0.84–1.14) | 0.811 | |||||
School type (girls’ vs. co-ed) | 0.65 (0.51–0.82) | <0.001 | |||||
Random effect | |||||||
Variance | 0.69 | <0.001 | 0.51 | <0.001 | 0.28 | <0.001 | |
ICC | 0.17 | 0.13 | 0.08 | ||||
Deviance | 75,205.44 | 74,704.66 | 75,010.76 | ||||
Reliability | 0.769 | 0.705 | 0.572 |
Model Parameter | Model 1 Null Model | Model 2 Unconditional Slope Model | Model 3 Final Model | ||||
---|---|---|---|---|---|---|---|
OR (95%CI) | p | OR (95%CI) | p | OR (95%CI) | p | ||
Fixed effect | |||||||
Level 1 | Intercept γ00 | 2.79 (2.62–2.98) | <0.001 | 5.47 (4.82–6.21) | <0.001 | 6.97 (5.66–8.58) | <0.001 |
Sex (boy vs. girl) | 0.25 (0.23–0.28) | <0.001 | 0.25 (0.23–0.28) | <0.001 | |||
Grade (1st vs. 3rd) | 0.93 (0.85–1.02) | 0.120 | 0.93 (0.85–1.02) | 0.119 | |||
Grade (2nd vs. 3rd) | 0.90 (0.82–0.99) | 0.030 | 0.90 (0.82–0.99) | 0.029 | |||
Self-reported economic status (lower vs. upper) | 1.07 (0.98–1.18) | 0.114 | 1.09 (1.00–1.19) | 0.055 | |||
Self-reported economic status (middle vs. upper) | 1.17 (1.10–1.24) | <0.001 | 1.17 (1.11–1.25) | <0.001 | |||
Academic performance (lower vs. upper) | 0.75 (0.69–0.81) | <0.001 | 0.75 (0.69–0.81) | <0.001 | |||
Academic performance (middle vs. upper) | 0.93 (0.86–1.01) | 0.070 | 0.93 (0.86–1.00) | 0.059 | |||
Self-reported health status (unhealthy vs. healthy) | 2.07 (1.94–2.22) | <0.001 | 2.08 (1.94–2.23) | <0.001 | |||
Self-reported oral health status (unhealthy vs. healthy) | - | - | - | - | |||
Experience of stress (yes vs. no) | - | - | - | - | |||
Experience of depression (yes vs. no) | - | - | - | - | |||
Oral symptoms (yes vs. no) | 1.11 (1.05–1.17) | <0.001 | 1.10 (1.04–1.17) | <0.001 | |||
Level 2 | School system (vocational vs. general) | 0.80 (0.72–0.89) | <0.001 | ||||
School type (boys’ vs. co-ed) | 1.14 (1.03–1.26) | 0.013 | |||||
School type (girls’ vs. co-ed) | 1.05 (0.90–1.23) | 0.599 | |||||
Random effect | |||||||
Variance | 0.41 | <0.001 | 0.14 | <0.001 | 0.13 | <0.001 | |
ICC | 0.11 | 0.04 | 0.04 | ||||
Deviance | 77,688.94 | 77,807.54 | 77,805.90 | ||||
Reliability | 0.826 | 0.611 | 0.593 |
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Kwak, S.-H.; Lee, H.-J.; Shin, B.-M. Do School-Level Factors Affect the Health Behaviors of High School Students in Korea? Int. J. Environ. Res. Public Health 2022, 19, 751. https://doi.org/10.3390/ijerph19020751
Kwak S-H, Lee H-J, Shin B-M. Do School-Level Factors Affect the Health Behaviors of High School Students in Korea? International Journal of Environmental Research and Public Health. 2022; 19(2):751. https://doi.org/10.3390/ijerph19020751
Chicago/Turabian StyleKwak, Seon-Hui, Hyo-Jin Lee, and Bo-Mi Shin. 2022. "Do School-Level Factors Affect the Health Behaviors of High School Students in Korea?" International Journal of Environmental Research and Public Health 19, no. 2: 751. https://doi.org/10.3390/ijerph19020751