| ObjectivesIn the current study,our first goal was to construct an adolescent concise health index(ACHI)indicator system,and determine the weight coefficient of each health indicator,as well as to establish the comprehensive evaluation method of ACHI.Finally,we carried out an empirical research was to verify its validity.MethodsIn study 1,we preliminarily proposed the ACHI indicator system,based on literature review,policy report review,core research group discussion and two rounds of expert consensus.In study 2,first,Yaahp 10.3 software was used to build a hierarchical model and expert consultation questionnaire,a total of 24 expert opinions were collected,and the analytic hierarchy method(AHP)was used to calculate the subjective weight(P_j)of each indicator.Second,relying on the Chinese Adolescent Health Monitoring and Cohort Study,from October to December 2021,region A and region B were selected with stratified cluster sampling method.A total of 10 schools were selected,including one urban middle school,one high school and one vocational high school,and one rural middle school and one high school,respectively.A valid sample of 4 364students were included as research objects.Of these,2 472(56.6%)were boys and 1892(43.4%)were girls,with an average age of 14.67±1.73 years.Information on general demographic characteristics,psychological and behavioral health was collected through questionnaire surveys,and indicators such as height,weight,waist circumference and grip strength were collected by professional medical examiners using unified measurement methods,the CRITIC method was used to calculate the objective weight(Q_j)of each indicator.Then,the AHP—CRITIC combined empowerment method was used to calculate the weight coefficients of each indicator in different sections and gender groups.Final,the TOPSIS method was used for comprehensive evaluation.Moreover,t test was used to compare the overall difference of ACHI in the two regions.In study 3,another urban middle school,urban high school,rural middle school and rural high school were selected from region A,a total of 4 schools.Questionnaire survey and physical examination were carried out in first-grade students,and blood samples were collected for the detection of allostatic load(AL)index.A total of 1 323middle school students were included in the valid sample for analysis.Among them,776(58.7%)were boys and 547(41.3%)were girls,with an average age of14.18±1.45 years.Based on the weight coefficients of each indicator determined in study 2,ACHI was established by TOPSIS method.Spearman correlation was used to analyze the correlation between ACHI and different AL scores and suicidal psychological behavior scores.Meanwhile,multiple linear regression model(MLR)was used to analyze the associations of ACHI with different AL scores and suicidal psychological behavior scores,so as to verify the effectiveness of ACHI.All data processing and statistical analysis were used SPSS(version 23.0;SPSS Inc)and R(version 4.2.2;R Development Core Team),graphs were produced using Graph Pad Prism software(version 9.0;Graph Pad Software Inc).The test levelα=0.05.ResultsIn study 1,a total of 18 expert suggestions and opinions were collected,of which 10were adopted,2 were partially adopted,and 6 were not adopted.Finally,the ACHI index system was constructed from five dimensions,namely physical growth,physical fitness,common diseases,mental health and behavioral health.A total of nine indicators:body mass index(BMI),waist circumference,relative grip strength,myopia,dental caries,psychological symptoms,physical exercise,screen time and sleep duration.In study 2,the subjective weights of each indicator were:BMI,0.1050;waist circumference,0.0762;relative grip strength,0.1275;myopia,0.0194;dental caries,0.0287;psychological symptoms,0.3579;physical exercise,0.0803;screen time,0.0494;sleep duration,0.0957.And the consistency test CR=0.0201<0.1,which indicated that the results were consistent well.A total of 4 364 middle school students were analysed,the results showed that in different classes and genders,the objective weight ranges of each health indicator were:BMI,0.0565～0.0846;waist circumference,0.0640～0.0856;relative grip strength,0.0749～0.0893;myopia,0.1401～0.1770;dental caries,0.0802～0.1111;psychological symptoms,0.1217～0.1668;physical exercise,0.0900～0.1489;screen time,0.1448～0.1721;sleep duration,0.0765～0.1095;among which screen time,psychological sub-health and myopia accounted for a relatively large proportion.The range of combined weight coefficients were:BMI,0.0808～0.0948;waist circumference,0.0701～0.0809;relative grip strength,0.1012～0.1084;myopia,0.1098～0.1282;dental caries,0.0545～0.0699;psychological symptoms,0.2398～0.2623;physical exercise,0.0852～0.1146;screen time,0.0971～0.1108;sleep duration,0.0861～0.1026;among which psychological symptoms accounted for the largest proportion and dental caries accounted for the smallest.The ACHI in city A(0.6262)was higher than that in city B(0.6134),and the difference was statistically significant(t=6.335,p<0.001).In study 3,a total of 1 323 participants were analyzed,the results indicated that the level of health index among male was higher than that of female,and the difference was statistically significant(t=6.039,p value<0.001).Spearman correlation analysis showed that the ACHI level was negatively correlated with different AL scores in the total sample(r value was between-0.098 to-0.176,p value<0.01).Similarly,the ACHI level was negatively correlated with suicidal psychological behavior scores(r=-0.332,p value<0.01).In addition,overall,MLR model analysis showed that there was a significant negative association between ACHI and different AL scores before and after adjusting for confounding factors(p value<0.01).Moreover,the results did not change even after gender stratification.ConclusionsIn this study,the ACHI indicator system was constructed from five dimensions,namely physical growth,physical fitness,common diseases,mental health and behavioral health,which has a good application value.A comprehensive evaluation method for ACHI was established by combining subjective and objective weighting method,as well as TOPSIS method,which has a good consistency.The ACHI was negatively correlated with different AL scores and suicidal psychological behavior scores.The stability of the research results is good,and the empirical validity is high,which can be used as an effective tool for comprehensive evaluation of adolescent health. |
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