| BackgroundA quote goes that "The youth is strong;the country is strong".The World Health Organization(WHO)put forward a new definition of Health in 1948,which states that"Health is a state of complete physical mental and social well-being and not merely the absence of disease or infirmity".Adolescence is a critical period for mental and physical growth.The physical conditions of this group not only effect personal growth,but also matter to the whole nation's health quality and the bright future.Given all of this,the Central Committee of the Chinese Communist Party and State Council attached great importance to the physical conditions of the vast majority of adolescent students,which was fully demonstrated by the "issuance of suggestions on strengthening the physical education to enhance physical condition of adolescents" in 2007.Adolescence is of great importance for laying solid foundation for adulthood.However,it is also a period when the health-related behaviors and disease which are hidden behind the main non-infective diseases are started and worsened.In 2011,WHO also pointed out that emphasis shall be put upon the health issues of the adolescents,and that measures shall also be taken to promote the cultivation of healthy behaviors in adolescents,reducing the risk of being attacked.Shandong has a large population,among which the number of primary and secondary students is over 10 million,accounting for 12.6%of the total provincial population,7%of the total number of primary and secondary students in China.Therefore,the performance of monitoring and evaluating the health status of primary and secondary students in Shandong Province as a target group,will have great impact on the evaluation and analysis of the student's physical conditions nationwide.Currently,many domestic scholars and scientific research institutes have launched evaluation programs for the health status of the target group.However,most of the evaluations only focused on the body shape and physical growth indicators;the comprehensive evaluation study on the health status of primary and secondly school students were seldom to carried out on the basis of considering various physical diseases.From the literature available,there are few systematic studies on the comprehensive evaluation of the health status of primary and secondary school students.At present,the comprehensive evaluation methods are mainly synthetic index method,analytic hierarchy process,fuzzy synthesis method,etc.To our knowledge,no artificial neural network model has been used to comprehensively evaluate the health status of primary and secondary school students;in addition,no relevant research on spatial statistical analysis of the health status of primary and secondary school students has been found.It is of great theoretical and practical value in improving the health level of primary and secondly school students and promoting sustainable economic and social development in Shandong Province via getting a good knowledge of students' health status and spatial distribution in the province scope and formulating targeted policies and feasible suggestions.ObjectivesBased on the literature review and related theoretical analysis,this study used the health examination data of primary and secondary school students to descriptively analyze the indicators of morphological,functional and physical diseases of primary and secondary school students in Shandong Province,and using analytic hierarchy process combined with artificial neural network model to comprehensive evaluation of the physical health of primary and secondary school students.At the same time,the spatial statistical analysis method is used to understand the spatial distribution of the health status of primary and secondary school students in different regions and the related social-economic factors of that distribution.According to the analysis results and discussion,the relevant countermeasures and suggestions are put forward,and provide theoretical guidance and research reference in perfecting health management strategy of primary and secondly school students in Shandong Province,improving students' health level,pushing forward Shandong sustainable economic and social development.The specific research objectives are as follows:(1)To propose comprehensive evaluation framework of primary and secondly school students after analyzing domestic and international literature and existing research,to provide appraisal reference for comprehensive evaluation and analysis of the health status of primary and.secondly school students in Shandong Province.(2)To give a descriptive analysis on health status of primary and secondly school students in Shandong province from the aspects of morphology,function and physical illness,etc.(3)To use the analytic hierarchy process to construct a comprehensive evaluation index system for the health status of primary and secondary school students,combined with the artificial neural network model to comprehensively evaluate the health status of students in Shandong Province.(4)To use spatial statistical analysis methods,the spatial distribution of health status of primary and secondary school students and related socio-economic factors are analyzed according to gender and regional levels.(5)To present analysis results,give relevant advice,provide theoretical guidance and research reference in perfecting health management strategy of primary and secondly school students in Shandong Province,enhancing students' health level,pushing forward Shandong sustainable economic and social development.Data and Methods(1)Data source and Research objective:The source is from the physical examination data of primary and secondly school students in Shandong province in 2017.The research objective is all the students from public primary and secondary schools and vocational schools,with 7 to 18 as the target age.(2)Research methods:By using the literature analysis,Delphi method,analytic hierarchy process,artificial neural network model,spatial statistical analysis and other methods.According to the results of the literature analysis,the comprehensive evaluation index of primary and secondary school students' health was put forward,and the system of comprehensive evaluation index was established.This system includes 3 categories and 7 indicators,which are respectively body shape(BMI index),physiological function(vital capacity index),and physical disorders(overweight-obesity,emaciation,growth retardation,dental caries,and eyesight dysfunction).The weight coefficient of the first and second indicators,and the score of each indicator were determined.According to the results calculated by the analytic hierarchy process(AHP),an artificial neural network model(BPNN)was constructed to comprehensively evaluate the health status of primary and secondary school students.According to the comprehensive evaluation results,descriptive research methods,Geographic Information System(GIS),spatial distribution maps,etc.will be used to describe the health comprehensive evaluation scores students,and reveal the health status of primary and secondary school students in different regions.At the same time,the least-squares regression analysis(OLS)and geographically weighted regression(GWR)were used to analyze the relevant social-economic factors.Main ResultsA total of 6216076 primary and secondary school students aged 7-18 years old were included in the study,with an average age of 10.87±2.64 years old,including 49.43%for boys and 50.57%for girls.Among male students,urban accounted for 62.54%,rural accounted for 37.46%;among female students,urban accounted for 59.16,and rural accounted for 40.84%.The morphological indicator:The average BMI index of students was 18.63±3.42 and BMI increases with age.From a gender perspective,the BMI of boys and girls was 18.75±3.43 and 18.50±3.40,respectively,and the difference is statistically significant(P<0.05).The BMI of boys in the 7?12 age group is higher than that of girls.After 12 years,girls are higher than boys.From the perspective of urban and rural,the BMI of urban and rural's students was 18.81 ±3.52 and 18.51 ±3.34,respectively,and the BMI of urban students in all age groups was slightly higher than that of rural students(P<0.05).The standard score of morphological indicator was 72.58±12.57,and the average score of boys(72.94)was slightly higher than that of girls(72.23)(P<0.05);The average score of urban students(72.54)is slightly lower than that of rural students(72.64)(P<0.05).From the changes of the average scores of students in different ages.he average score gradually decreases with age,indicating that the morphological indicators of primary and middle school students deteriorated.The Physiological function indicator:The average index of vital capacity weight of students was 47.18 ±13.50,and the index of boys and girls was 48.40±13.83 and 45.97± 13.05,respectively.The index of vital capacity weight among boys is significantly higher than that of girls,and the gap between male and female weight-earth index after age 12 increases with age.The vital capacity weight index of boys is higher than that of girls,and after 12 years of age,the gap between male and female is increasing with age.The standard score of physiological function indicator was 70.18±8.41,and the average score of boys(69.45)was slightly lower than that of girls(70.90)(P<0.05);The average score of urban students(70.05)is slightly lower than that of rural students(70.26)(P<0.05).According to physiological function level composition,the composition ratios of the upper,middle upper,middle,lower middle and inferior were 3.7%,22.7%,47.9%,23.2%,and 2.5%,respectively.In addition,the older the age,the better the physiological function of girls,the trend of boys is just the opposite.The physical ailment indicator:(1)Nutritional status.The detection rate of overweight and obesity among students were 15.1%and 9.2%,respectively.From a gender perspective,the detection rates of overweight and obesity in boys were 17.4%and 10.5%,respectively,and girls were 12.7%and 8.0%,respectively.Boys were significantly higher than girls(P<0.05).From the perspective of urban and rural areas,the overweight and obesity detection rates of urban students were 16.3%and 9.8%,respectively,and that of rural students were 14.2%and 8.8%,respectively.The former was higher than the latter,and the difference was statistically significant(P<0.05).From the perspective of age changes,the detection rate of obesity and overweight among primary school students is significantly higher than that of middle school students.The detection rate of mild emaciation and moderate to severe emaciation were 3.4%and 2.5%,respectively.From a gender perspective,the detection rates of mild emaciation and moderate to severe emaciation in boys were 4.2%and 2.8%,respectively,and girls were 2.7%and 2.1%,respectively,and boys were significantly higher than girls(P<0.05).From the perspective of urban and rural areas,the detection rates of mild emaciation and moderate to severe emaciation in urban students were 3.5%and 2.50%,respectively,and that of rural students were 3.4%and 2.4%,respectively.The former was slightly higher than the latter(P<0.05).The detection rate of microsomia and growth retardation of students is low,but the detection rate of growth retardation of rural students is significantly higher than that of urban students.In most age groups,the detection rate of male students is higher than that of female students.(2)Poor vision:The detection rate of poor vision among students in the whole province was 32.3%.The detection rates of visual acuity in boys and girls were 27.9%and 36.7%,respectively,and the difference was statistically significant(P<0.05).The detection rates of visual acuity in urban students and rural students were 39.3%and 27.9%,respectively.The difference was statistically significant.The detection rate of poor vision increases with age.The detection rate of moderate and severe visual acuity was over 50%for girls and urban students at the age of 14 and beyond,and the proportion of girls at the age of 17 reached 74.68%,close to 3/4;The detection rate of moderate and severe visual impairment in boys and rural areas was over 50%at the age of 15 and later,and the proportion of male students at the age of 17 reached 67.86%,more than 2/3.(3)Mixed caries.The detection rate of mixed caries among students in the whole province was 18.7%.The detection rates of mixed caries among boys and girls were 17.8%and 19.5%,respectively,and the difference was statistically significant(P<0.05).The detection rates of mixed caries among urban students and rural students were 18.8%and 18.6%,respectively.The difference was statistically significant(P<0.05).The detection rate of mixed caries among girls of all ages was higher than that of boys.After the age of 12,the detection rate of mixed caries in urban students is slightly higher than that of rural students,but the gap is small.(4)Standard score of physical ailment.The average score of physical ailment was 76.14±11.83,the average score of boys was 74.04±11.95,and the average score of girls was 76.23± 11.71.The difference was statistically significant(P<0.05).From the changes in the standard scores of health disorders of different ages,the scores of health disorders gradually decreased with age.Among them,12 years old and before,the scores of girls' health diseases were higher than boys,and after 12 years old,boys were better than girls.Rural students are healthier than urban students in all age groups.Comprehensive health evaluation:The comprehensive health evaluation of primary and secondary school students in the province was 74.99±8.13.The score of comprehensive evaluation of boys was 74.81 ±8.34,that of girls was 75.16±7.83;the average score of urban students was 74.26±8.12,and that of rural students was 75.46±8.11.The scores of comprehensive evaluations of health from 7 to 16 years old showed a downward trend with age.After 16 years old,the scores were relatively stable.The scores in all ages showed a trend higher in rural areas than in cities.Before the age of 13,girls scored higher than boys.After 13 years old,they were gradually lower than boys.Spatial distribution of health status:From the perspective of the whole province,the comprehensive health status of primary and middle school students in rural areas is better than that in urban areas,and girls are better than boys.From the perspective of spatial distribution,the high-level distribution is mainly distributed in the southwest and northwest of Shandong Province,while the comprehensive evaluation of health scores in Jiaodong Peninsula is relatively low.There is still a significant difference in the comprehensive evaluation score even if in adjacent areas,which indicates the spatial heterogeneity and structural coexistence of the comprehensive evaluation scores of the primary and secondly school students in the whole province.This significant difference happens to both gender and area.Analysis of factors affecting omprehensive health status:The results of OLS regression and GWR regression show that per capita GDP,household consumption level,primary and secondary industry ratio and number of medical institutions are the main social-economic factors affecting the distribution of health status among primary and secondary school students.The regression coefficient of per capita GDP is negative,and the coefficient gradually decreases from northeast to southwest,suggesting that the more underdeveloped economy,the higher the comprehensive health scored;The regression coefficient of household consumption level is negative,and the coefficient gradually decreases from southwest to northeast,suggesting that the higher the level of household consumption,the lower the overall health scored;The regression coefficient of industrial ratio is positive,and the coefficient gradually decreases from west to east,suggesting that the area with the larger proportion of the primary industry,the higher the health comprehensive scored;The regression coefficient of the number of medical institutions is negative,and coefficient gradually increases from west to east,suggesting that the more the number of medical institutions,the lower the overall health scored.Conclusions and SuggestionsConclusions:The comprehensive health evaluation score of students was 74.99±8.13,and the medium level was the most common among the three evaluation indicators(Physiological function indicator,Morphological indicator,Physical Ailment).Before 13 years old,girls' health scores were higher than boys',and after 13 years,boys scored higher than girls;rural students' health scores were higher than urban students.Students of different ages,different sexes,urban and rural areas are generally within the normal range of physical shape,the body is well developed,and the boys were better than girls,rural students were better than urban students.The physiological functions of students of different ages,genders,and urban and rural areas are generally in good condition.The physiological function level of boys is basically stable,and the physiological functions of girls are better.With the age increasing,the detection rate of overweight and obesity of different gender students decreased significantly,and the detection rate of poor visual acuity showed a rapid growth trend,especially the detection rate of moderate and severe visual acuity decreased significantly.Obesity,overweight and dental caries are serious health problems faced by primary school students.Moderate and severe visual acuity are important health problems for middle school students.The spatial distribution shows that the comprehensive health scores of primary and middle school students in Shandong Province have obvious spatial correlation and spatial clustering.The high-level scores of the comprehensive evaluation scores of primary and middle school students are mainly distributed in the southwest and northwest of Shandong Province,while the health comprehensive score of Jiaodong Peninsula is relatively low.The results of spatial regression analysis show that when the social and economic conditions are more general,the macroeconomic situation and the input of social resources have a greater impact on the health of primary and secondary school students.However,when the social and economic conditions develop to a certain stage,the effect is no longer significantly improved,and accompanied with others factors.Suggestions:(1)Establish a "health first" concept and form a healthy atmosphere.(2)Strengthen the health checkup of primary and secondary school students to ensure the healthy development of mind and body.(3)Aiming at the major health problems of different individual and group of students,to achieve precise force and classification policy.(4)Popularize health education and establish a healthy and healthy lifestyle.(5)Conduct monitoring and evaluation of students' health hazards,and strengthen prevention and treatment of common diseases such as myopia,dental caries and obesity.(6)Strengthen physical exercise and promote physical and mental health of students.(7)Launch a patriotic health campaign to create a healthy environment.(8)Strengthen the construction of school health talents and improve the health education security system.Innovations and LimitationsThe innovations of this study:1)For the first time,the health examination data of primary and middle school students in Shandong Province was used,and the comprehensive evaluation model was constructed by the combination of AHP and artificial neural network.The health status of primary and middle school students in Shandong Province was comprehensively evaluated.2)For the first time,the spatial statistical analysis method was used to analyze the comprehensive evaluation of primary and secondary school students' health.At the same time,a weighted geographic regression model was constructed to explore the macro-social-economic factors affecting the health status of students in different regions,and which provided new ideas for similar research in the future.The limitations of this study:1)Limited by the availability of data,this study only carried out a cross-sectional analysis of the 2017 data,without longitudinal dynamic analysis,so it is impossible to reveal the dynamic changes in the health status of primary and secondary school students.2)Only the impact of macro-social-economic factors on the health of primary and secondary school students was analyzed,and the analysis of micro-influence factors is lacking. |
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