**1. Introduction**

Being healthy is an essential part of any adolescent life. In fact, youths with a positive health status have higher chances to grow into healthy adults, as several serious diseases (e.g., cardiorespiratory fitness, mental disorders) that generally occur in adulthood originate from health issues during adolescence [1]. Although several approaches exist to study people's health status, individual self-perception has grown as one of the most interesting methods due to several advantages. Compared to medical records, self-perception tools are easier to apply, allow for encompassing broader strata of the population at lower costs, and have been shown to be a valid assessment strategy [2]. Although there exist some differences due to sociodemographic factors compared to the objective assessment of health, these two methods are deemed to obtain comparable findings [2].

Perceived health status is influenced by several socioenvironmental and personal factors. Studies found a positive association between physical fitness and perceived health in youth, especially in terms of cardiorespiratory and muscular fitness [3,4]. Participation in organized sports activities may also be an essential contributor to perceived health as there exists a positive relationship between sports participation and perceived health regardless of the sociocultural environment [5,6]. In addition, children with healthier body mass index

**Citation:** Cocca, A.; Niedermeier, M.; Prünster, V.; Wirnitzer, K.; Drenowatz, C.; Greier, K.; Labek, K.; Ruedl, G. Self-Rated Health Status of Upper Secondary School Pupils and Its Associations with Multiple Health-Related Factors. *Int. J. Environ. Res. Public Health* **2022**, *19*, 6947. https://doi.org/10.3390/ ijerph19116947

Academic Editor: Paul B. Tchounwou

Received: 6 May 2022 Accepted: 4 June 2022 Published: 6 June 2022

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**Copyright:** © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

(BMI) display enhanced perceived health status or higher perception of health-related self-efficacy [7,8]. Furthermore, BMI and weight status may indirectly affect perceived health through associations with active habits and nutritional and lifestyle choices [9].

On the other hand, unhealthy behaviors, such as tobacco and alcohol consumption, excessive screen time and electronic media use, and back pain, can be mentioned as prominent sources of reduced health perception in youth [9–11]. Tebar et al. [12] showed a worse health perception in youth with a higher number of sedentary activities, regardless of their physical activity habits. Prolonged sitting and excess screen time are also related to back pain at early ages [13,14], which has a detrimental effect on perceived health as well [11,15].

Although previous studies have investigated the separate effect of the factors mentioned earlier on perceived health, to date, there are only a few studies addressing their intertwined action. Perceived health, however, is the result of the combination of physical, social, environmental, and demographic agents, and its alteration cannot be fully understood without considering this wide spectrum of variables. The aims of this study, therefore, are to evaluate the current perceived health of upper secondary school pupils and its associations with multiple health-related factors; to compare physical, social, and environmental variables by health status; and to analyze the explanatory power of such variables on perceived health status.
