| The"Health China 2030"plan outlines the need to shape autonomous and self-disciplined health behaviors and strengthen intervention measures to promote healthy growth of adolescents.In recent years,the situation of health risk behaviors among adolescents in China has been serious,with injuries replacing physical diseases as the leading cause of death among adolescents in China,bullying in schools is widespread,and obesity caused by poor diet is spreading rapidly.Health risk behaviors not only seriously affect the healthy growth of adolescents,but also are an important basis for the development of certain adult diseases,and even cause serious social problems.There are many kinds of health risk behaviors,all kinds of behaviors are closely related to each other,with significant aggregation characteristics,and when the health risk behaviors are in a state of aggregation,the damage to health has a synergistic effect,and its harmfulness is significantly increased,and the difficulty of prevention and treatment is significantly increased,so it should be given sufficient attention.The economic development of Wuling Mountain area is relatively backward,and the incidence of health risk behaviors among adolescents is high.An in-depth study on their aggregation characteristics,influencing factors,mechanism of action,and integrated intervention of education and sports can provide an important reference basis for preventing and reducing health risk behaviors,cultivating healthy behaviors among adolescents,forming healthy lifestyles,and promoting healthy growth.Objectives:We collected basic data on the occurrence of adolescent health risk behaviors in the Wuling Mountains,analyzed the aggregation characteristics of adolescent health risk behaviors,explored the influencing factors of the aggregation of health risk behaviors and their mechanisms of action,developed an integrated intervention model of education and sports with adolescent signature behaviors as the target of intervention,and verified its evidential effects to provide a reference basis for the prevention and treatment of adolescent health risk behaviors in the Wuling Mountains.Methods:(1)Using the multi-stage random whole group sampling method,7,901adolescents from 48 schools in the Wuling Mountains were selected and surveyed using the"Questionnaire on Adolescent Health Hazardous Behaviors in the Wuling Mountains",SPSS 25.0 was used to conduct descriptive statistics,χ2 test was used to explore the multiple characteristics of adolescent health hazardous behaviors in the Wuling Mountains,the aggregation risk measurement model was used to analyze the aggregation pattern of health hazardous behaviors.The potential categories of health hazards were analyzed using Mplus 8.3 software with 11 health hazards as classification indexes.(2)SPSS 25.0 software was used for multivariate logistic regression to explore the influencing factors of aggregation of health hazards.(3)SPSS Process v3.5 plug-in was used to analyze the mechanism of the influencing factors of aggregation and to test for mediating effects.(4)Ucinet 6.6 software was used to conduct network density and network centrality analysis to determine the signature behaviors of the high-risk model group,search published literature through domestic and international databases such as China Knowledge Network,Wanfang,Pub Med,Web of Science,etc.,use Rev Man 5.3software to conduct meta-analysis combined with the actual conditions to determine the physical exercise elements of the teaching and physical integration intervention model,use The literature data method was used to determine the health education elements of the intervention model,and to construct an integrated teaching-study intervention model for adolescents’health risk behaviors in the Wuling Mountains.(5)One hundred and twenty-five adolescents in the high-risk model group were selected as intervention subjects and randomly divided into four groups:physical exercise group,health education group,teaching-study integration group and control group.The differences between pre-experimental and post-experimental health-harming behaviors and influencing factors were tested by paired-sample t-test.Results:(1)The analysis of multiple characteristics found that 1790(22.7%)adolescents in the Wuling Mountains did not engage in health risk behaviors,1849(23.4%)engaged in one health-hazardous behavior,1237(15.7%)engaged in two health risk behaviors,924(11.7%)engaged in three health risk behaviors,666(8.4%)engaged in four health risk behaviors,and There were statistically significant differences in the prevalence of health hazards among adolescents by gender(χ~2=41.503),school band(χ~2=73.855),and urban-rural characteristics(χ~2=93.939)(P<0.05).The analysis of clustering patterns revealed that the risk of"loneliness"clustering was the highest among adolescents in the Wuling Mountains(OR=60.29);the incidence of"suicidal ideation+depressive symptoms"was the highest in the binary clustering pattern(18.3%),and the incidence of"smoking+drinking"was the highest.(O/E=6.6);ternary clustering pattern of"partial eating+self-injurious behavior+suicidal ideation"(13.0%)and"smoking+drinking+fighting"(O/E=20.6);quadratic aggregation pattern"loneliness+self-injurious behavior+suicidal ideation+depressive symptoms"(7.0%),"smoking+drinking+fighting+insomnia"(O/E=48.8);The five element aggregation pattern"insomnia+loneliness+self-injurious behavior+suicidal ideation+depressive symptoms"had the highest prevalence(4.4%),and"smoking+drinking+insomnia+loneliness+school bullying"had the highest aggregation risk(O/E=212.1).The analysis of potential categories revealed that the health risk behaviors of adolescents in the Wuling Mountains could be divided into four categories:low-risk group(56.9%),medium-risk group(27.5%),higher-risk group(6.0%),and high-risk group(9.6%),and the high-risk model groups were partial eating(56.7%),insomnia(67.5%),loneliness(79.1%),self-injurious behavior(89.3%),suicidal ideation(94.9%),and depressive symptoms(98.1%).),depressive symptoms(98.4),cell phone addiction(60.9%),and school bullying(56.9%)had the highest prevalence,and smoking(21.3%),drinking(30.4%),and fighting(54.4%)had higher than average prevalence.(2)The analysis of factors influencing multiple characteristics found that,using the occurrence of 0 to 1 species as the reference category,boys(OR=0.728,95%CI:0.604～0.879),rural areas(OR=0.609,95%CI:0.457～0.781),better academic performance(OR=0.706,95%CI:0.544～0.918),and higher parent-child relationship scores(OR=0.927,95%CI:0.911～0.942),higher school connectedness scores(OR=0.915,95%CI:0.900～0.930),higher peer relationship scores(OR=0.971,95%CI:0.955～0.988),higher self-efficacy scores(OR=0.944,95%CI:0.926～0.964),and self-control scores(OR=0.917,95%CI:0.908～0.925)were protective factors for the occurrence of≥5 health risk behaviors;high scores of adverse childhood experiences(OR=1.455,95%CI:1.371～1.543)were risk factors for the occurrence of≥5 health risk behaviors(P<0.05).The analysis of factors influencing potential category characteristics found that,using the low-risk group as the reference category,boys(OR=0.763,95%CI:0.618～0.943),rural areas(OR=0.665,95%CI:0.501～0.882),high parent-child relationship scores(OR=0.933,95%CI:0.916～0.950),school connectedness scores(OR=0.888,95%CI:0.872～0.904),high self-efficacy scores(OR=0.884,95%CI:0.871～0.897),and high self-control scores(OR=0.929,95%CI:0.920～0.938)were protective factors for the high-risk group;junior high school level(OR=1.326,95%CI:1.009～0.938).95%CI:1.009～1.742),left-behind children(OR=1.322,95%CI:1.046～1.671),family integrity(OR=1.365,95%CI:1.058～1.762),and high scores of adverse childhood experiences(OR=1.769,95%CI:1.668～1.876)were risk factors in the high-risk group(P<0.05).(3)The analysis of the mechanism of action of the factors influencing the aggregation of health risk behaviors revealed that:adverse childhood experiences positively influenced the aggregation of health risk behaviors with a total effect of 0.642,a direct effect of 0.478(74.5%),and three mediating effects consisting of self-efficacy,self-control,and self-efficacy-self-control with a total effect size of 0.134(25.5%)(P<0.05).The total effect of school association negatively influenced the clustering of health risk behaviors,with a total effect of-0.130 and a direct effect of-0.085(65.4%),and the total effect of the 2 mediated effects of self-control and self-efficacy-self-control was0.045(34.6%)(both P<0.05);peer relationships negatively influenced the clustering of health risk behaviors,with a total effect of-0.158 and a direct effect of-0.104 and a direct effect of-0.104(65.6%),with a total effect size of-0.054(34.4%)for the 3mediated effects of self-efficacy,self-control,and self-efficacy-self-control(P<0.05).(4)The social network centrality analysis showed that the depression centrality(4554.0),relative centrality(64.322),and shared centrality(0.134)were the highest among adolescents in the Wuling Mountains;the teaching and sports integration intervention model took depression symptoms as the target of intervention,and the project types of physical exercise elements used individual projects(badminton,rope skipping),group projects(soccer)and sports games combined.The exercise cycle was10 weeks,the frequency of exercise was 2-3 times per week,the duration of exercise was 45 min each time,and the intensity of exercise was 60.0%～75.0%HRmax;the content of the health education element included 5 thematic lectures on happy growth,self-confidence development,communication and cooperation,emotion regulation,and stress coping,which were conducted once every 2 weeks for 45 min each time,for a total of 5 times.(5)The experimental results showed that the post-experimental scores of depressive symptoms(t=6.649,d=1.356),smoking(t=2.536,d=1.032),loneliness(t=3.196,d=1.046),suicidal ideation(t=3.375,d=0.659),and cell phone addiction(t=3.367,d=1.002)were lower in the teaching and physical integration group than in the pre-experimental The difference between the pre-and post-experimental scores was statistically significant(P<0.05),and the self-efficacy(t=-4.545,d=-0.642)scores were higher than the pre-experimental scores.Multiple comparisons showed that the teaching and physical integration group had lower depressive symptom scores than the physical exercise group(t=-2.517,d=0.649)and the control group(t=-7.771,d=1.996),and lower cell phone addiction scores than the physical exercise group(t=-1.287,d=0.332),the health education group(t=1.734,d=0.447)and the control group(t=-3.878,d=1.001),and smoking(t=2.908,d=0.751)and loneliness(t=5.862,d=1.513)scores were lower than those of the control group,and all differences were statistically significant(P<0.05).Conclusions:(1)most adolescents in the Wuling Mountains had≥2 health risk behaviors,the proportion of girls with≥2 health risk behaviors was higher than that of boys,the proportion was higher in the high school section than in the junior high school section,and the proportion was higher in urban than in rural areas;the aggregation patterns"suicidal ideation+depressive symptoms","partial eating+self-injurious behavior+suicidal ideation","loneliness+self-injurious behavior+suicidal ideation+depressive symptoms",and"insomnia+loneliness+self-injurious behavior+suicidal ideation+depressive symptoms"had the highest incidence in each category group;"loneliness","smoking+drinking","smoking+drinking+fighting","smoking+drinking+fighting+insomnia","smoking+drinking+insomnia+loneliness+school bullying"had the highest risk of clustering in each category group;all implicit behaviors and most explicit behaviors clustered in the potential high risk group.(2)Adolescents with good academic performance,good parent-child relationship,high level of school connectedness,good peer relationship,high self-efficacy,and high self-control were less likely to engage in≥5 health risk behaviors;adolescents with more adverse childhood experiences were more likely to engage in≥5 health risk behaviors.The likelihood of entering the high-risk pattern group was low among adolescents with good parent-child relationship,high level of school connectedness,high self-efficacy and strong self-control in Wuling Mountain area boys,rural areas,and higher likelihood among adolescents with middle school,left-behind children,intact families and more adverse childhood experiences.(3)Adolescents in Wuling Mountains can directly and positively influence the aggregation of health-harming behaviors,while parent-child relationship,school bonding and peer relationship can directly and negatively influence the aggregation of health-harming behaviors,and bad childhood experiences,parent-child relationship,school bonding and peer relationship can indirectly influence the aggregation of health-harming behaviors through the mediating effects of self-efficacy and self-control.(4)The integrated intervention model of education and sports for adolescents in the Wuling Mountains is a comprehensive intervention model that aims to reduce health risk behaviors,develop healthy lifestyles,and promote healthy growth of adolescents,with the signature behaviors of high-risk groups as the target of intervention and the organic integration of health education and sports elements.(5)The teaching-study integration intervention with depressive symptoms as the target behavior can reduce the occurrence of depressive symptoms in the signature behavior,and at the same time reduce the occurrence of various other health risk behaviors and improve the self-efficacy level,and the effect of the teaching-study integration group is better than that of the health education and physical exercise groups. |
