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Int. J. Environ. Res. Public Health 2013, 10(7), 2944-2978; doi:10.3390/ijerph10072944
Article

Distal and Proximal Factors of Health Behaviors and Their Associations with Health in Children and Adolescents

1,* , 2,†
,
3,†
 and
2,†
1 Technische Universität München, Georg-Brauchle-Ring 60/62, München 80992, Germany 2 Karlsruhe Institute of Technology, Engler-Bunte-Ring 15 Geb. 40.40, Karlsruhe 76131, Germany 3 Robert Koch Institute Berlin, Postfach 650261, Berlin 13302, Germany These authors contributed equally to this work.
* Author to whom correspondence should be addressed.
Received: 22 May 2013 / Revised: 4 July 2013 / Accepted: 5 July 2013 / Published: 16 July 2013
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Abstract

Objective: The aim of the present paper was to analyze factors affecting distal and proximal health behavior within a biopsychosocial model for examining their interactions and associations with respect to health. Methods: Path analysis was based on the nationwide, cross-sectional German Health Interview and Examination Survey for Children and Adolescents (2003 to 2006). The data was collected from 4,529 participants with an average age of 9.45 years (SD = 4.01). Socio-demographic data, psychosocial factors and health behavior were assessed via questionnaire. Participants also underwent physical fitness tests and a medical examination. Results: Over the five levels of the model analyzed with socioeconomic status, immigration background, and rural-urban differences on the first level; physical activity of relatives and peers, intrinsic motivation, and quality of life on the second level; eating patterns, sedentary behavior, and physical activity on the third level; physical fitness and objective health on the fourth level; and health complaints and subjective health on the fifth level; direct, moderation, and mediation effects could be shown. Conclusions: Several distal and proximal factors are needed to take account of the multivariate complexity of health: e.g., immigration background affected health behaviors only indirectly and the effect of physical activity on objective health was mediated by physical fitness.
Keywords: psychosocial determinants; health behavior; objective health; health complaints; subjective health psychosocial determinants; health behavior; objective health; health complaints; subjective health
This is an open access article distributed under the Creative Commons Attribution License (CC BY 3.0).
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Lämmle, L.; Woll, A.; Mensink, G.B.M.; Bös, K. Distal and Proximal Factors of Health Behaviors and Their Associations with Health in Children and Adolescents. Int. J. Environ. Res. Public Health 2013, 10, 2944-2978.

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