Physical activity, screen time and self-rated health and mental health in Canadian adolescents
Introduction
Physical activity (PA) has established benefits on many aspects of health and quality of life across the lifespan (Mountjoy et al., 2011). Sedentary behaviour (SED), defined as any waking behaviour characterized by an energy expenditure of ≤ 1.5 METs while in a sitting or reclining posture (Sedentary Behaviour Research Network, 2012), is associated with negative health outcomes distinct from those of inactivity and independent from the benefits associated with PA (Herman et al., in press, Tremblay et al., 2010).
Self-rated health (SRH) is a multidimensional concept and a commonly used indicator of health-related quality of life (HRQL) (Centers for Disease Control and Prevention, 2000), powerfully and independently predicting morbidity and mortality in adults (Idler and Benyamini, 1997). Individuals construct their subjective responses to this single-item global health question according to multiple sources of information, including specific health conditions, general physical functioning and health behaviours, of which the relative importance varies by sociodemographic and health characteristics (Krause and Jay, 1994, Schuz et al., 2011). This spontaneous self-assessment of health relies on current health status and immediate physical cues, along with a more enduring self-concept held by the individual (Bailis et al., 2003).
Less is known about SRH in youth, of whom approximately 70% in Canada report excellent/very good health (Statistics Canada, 2012). A higher proportion of boys rate their health optimally compared to girls; proportions reporting excellent/very good health decline and gender differences widen through adolescence (Jerden et al., 2011, Tremblay et al., 2003, Vingilis et al., 2002). Adolescent self-perceptions of health appear to be framed not only by their physical health, but also by personal, socio-environmental, behavioural and psychological factors (Vingilis et al., 2002). Overall, younger people are more likely to use health behaviours (e.g. diet, exercise, alcohol, tobacco) as a referent rather than contemplating health problems when providing global health status assessments (Krause and Jay, 1994). SRH in adolescents is moderately stable over repeated observations, responses more strongly associated with prior responses than with health changes in the intervening time period; thus while partly a spontaneous health assessment, adolescent SRH may represent more of an enduring self-concept (Boardman, 2006). Similar to adults, positive associations between PA and SRH have been reported in youth (Elinder et al., 2011, Galan et al., 2013, Herman et al., 2014, Iannotti et al., 2009, Kantomaa et al., in press). Results from one large multi-national study also showed an inverse association between screen-based media use and SRH in youth aged 11–15 years (Iannotti et al., 2009).
A similar but more directed question, self-rated mental health (SRMH) has been far less studied than global SRH. This simple 1-item question does not substitute for more specific mental health measures, but has been validated in adults as a useful indicator for monitoring general mental health (Mawani and Gilmour, 2010). No prior reports were found examining PA or SED associations with SRMH in adults or youth. However, in adults PA has been associated with lower risk of psychological distress (Hamer et al., 2009) and better scores on general mental health scales (Kim et al., 2012) while SED time has been associated with higher risk of psychological distress (Hamer et al., 2014). Similarly, both PA and screen time ST have been linked with more specific mental health indicators in youth, including depression, anxiety/stress, self-esteem and cognitive functioning; associations have tended to be small and inconsistent, and several reviews have concluded the overall evidence base to be limited (Allison et al., 2005, Biddle and Asare, 2011, Brown et al., 2013, Cao et al., 2011, Ekeland et al., 2004, Kremer et al., 2014, Larun et al., 2006).
Currently fewer than 10% of Canadian youth are accumulating the minimum 60 min of moderate-to-vigorous PA daily (Colley et al., 2011) recommended by the Canadian PA Guidelines (Tremblay et al., 2011b), and youth are spending on average 8.6 h/day (62% of their waking hours) sedentary (Colley et al., 2011). Thus it is important to further explore how low levels of PA and high levels of SED are associated with self-perceptions of health, including a simple more general indicator of mental health, in representative samples of youth. The objectives of this study were to examine the associations of PA and ST with SRH and SRMH in a large representative sample of Canadian adolescents.
Section snippets
Data/sample
The study sample was drawn from the Canadian Community Health Survey (CCHS) 2011/2012 public use microdata file. In depth methodology has been published (Statistics Canada, 2013). Briefly, the CCHS is a cross-sectional survey conducted by Statistics Canada to collect information relating to health status, health determinants and health system utilization for the Canadian population. Using computer-assisted interviews (in-person or telephone), the CCHS targets persons ≥ 12 years of age living in
Results
Characteristics of the sample are presented in Table 1. Overall, 72% and 80% of adolescents reported excellent/very good SRH and SRMH, respectively. Just over half (52%) were classified as active (≥ 3 kcal/kg/day), while two-thirds (67%) exceeded the ST guidelines of 2 h/day; boys were significantly more active and more likely to exceed ST guidelines than were girls.
Excellent/very good SRH was reported by 78% of active vs. 62% of inactive adolescents (p < 0.001) (Fig. 1a), and 77% of those meeting
Discussion
This study explored the associations of PA and ST with SRH and SRMH in a large representative sample of Canadian adolescents. Over one quarter of adolescents reported sub-optimal SRH and one fifth reported sub-optimal SRMH, while half were classified as inactive and two thirds exceeded current ST guidelines recommending a maximum of 2 h/day. Inactive adolescents were more likely to report sub-optimal SRH and SRMH compared to their active peers, although the association between PA and SRMH was
Conclusions
PA is positively associated with SRH in Canadian adolescents, and to a weaker degree with SRMH in girls only once controlling for confounding variables. ST is independently inversely associated similarly with both SRH and SRMH, though the association between ST and SRH is weaker in magnitude than that of PA. PA and SED interventions aimed at teens should take into account self-ratings of health and mental health, with an eye to improving or maintaining HRQL in addition to biomedical outcomes.
Conflict of interest statement
The authors declare no conflict of interest.
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