Health  Vol.6 No.17 , October 2014
Clustering of Multiple Risk Behaviors among Ethnically Diverse Adolescents Living in Hawaii
Abstract: The current study examined the prevalence and clustering of 5 health-risk behaviors among adolescents in Hawaii, including physical inactivity, low fruit and vegetable consumption, junk food consumption, excessive television time, and inadequate sleep. High school students were recruited from 5 classrooms in Oahu Hawaii. Data were collected in the spring semester of 2011. Proportions were used to describe the prevalence of single and multiple health risk behaviors. Significant health behavior clusters were revealed using an observed-to-expected (O/E) ratio method. Participating adolescents (n = 114) were 11th and 12th grade students with a mean age of 16.28 (SD = 0.62). Participants were predominantly female (75%) and Filipino-American (68%). Seventy-seven percent of adolescents were physically inactive, 90% watched excessive TV, 66% consumed inadequate fruits and vegetables, 94% reported inadequate levels of sleep, and 80% consumed excessive junk food. Overall, 94% reported at least 3 risk factors, 73% reported at least 4 risk factors, and 37% reported all 5 risk factors. No significant clusters were found. Conclusion: Health-risk behaviors cluster and occur more often than expected among adolescents living in Hawaii. Non-significant clustering may be due to insufficient variability within the sample data; future examinations of this highly understudied population are necessary.
Cite this paper: Kahrs, J. and Geller, K. (2014) Clustering of Multiple Risk Behaviors among Ethnically Diverse Adolescents Living in Hawaii. Health, 6, 2333-2341. doi: 10.4236/health.2014.617268.

[1]   Ogden, C.L., Carroll, M., Kit, B. and Flegal, K.M. (2012) Prevalence of Obesity and Trends in Body Mass Index among US Children and Adolescents, 1999-2010. JAMA, 307, 483-490.

[2]   Cole, T.J., Bellizzi, M.C., Flegal, K.M. and Dietz, W.H. (2000) Establishing a Standard Definition for Child Overweight and Obesity Worldwide: International Survey. BMJ, 320, 1240-1243.

[3]   Nicklas, T.A., Yang, S.J., Baranowski, T., Zakeri, I. and Berenson, G. (2003) Eating Patterns and Obesity in Children. The Bogalusa Heart Study. American Journal of Preventive Medicine, 25, 9-16.

[4]   Janssen, I., Katzmarzyk, P.T., Boyce, W.F., Vereecken, C., Mulvihill, C., Roberts, C., et al. (2005) Comparison of Overweight and Obesity Prevalence in School-Aged Youth from 34 Countries and Their Relationships with Physical Activity and Dietary Patterns. Obesity Reviews, 6, 123-132.

[5]   Hart, C.N., Cairns, A. and Jelalian, E. (2011) Sleep and Obesity in Children and Adolescents. Pediatric Clinics of North America, 58, 715-733.

[6]   Guenther, P.M., Dodd, K.W., Reedy, J. and Krebs-Smith, S.M. (2006) Most Americans Eat Much Less than Recommended Amounts of Fruits and Vegetables. Journal of American Dietetic Association, 106, 1371-1379.

[7]   Troiano, R.P., Berrigan, D., Dodd, K.W., Masse, L.C., Tilert, T. and McDowell, M. (2008) Physical Activity in the United States Measured by Accelerometer. Medicine & Science in Sports & Exercise, 40, 181-188.

[8]   American Academy of Pediatrics, Committee on Public Education (2001) Children, Adolescents, and Television. Pediatrics, 107, 423-426.

[9]   Eaton, D.K., Kann, L., Kinchen, S., Shaklin, S., Flint, K.H., Hawkins, J. and Lim, C. (2012) Youth Risk Behavior Surveillance-United States. MMWR Surveillance Summaries, 61, 1-162.

[10]   Dahl, R.E. and Lewin, D.S. (2002) Pathways to Adolescent Health Sleep Regulation and Behavior. Journal of Adolescent Health, 31, 175-184.

[11]   Fredriksen, K., Rhodes, J., Reddy, R. and Way, N. (2004) Sleepless in Chicago: Tracking the Effects of Adolescent Sleep Loss during the Middle School Years. Child Development, 75, 84-95.

[12]   Alamian, A. and Paradis, G. (2009) Clustering of Chronic Disease Behavioral Risk Factors in Canadian Children and Adolescents. Preventive Medicine, 48, 493-499.

[13]   Alamian, A. and Paradis, G. (2009) Correlates of Multiple Chronic Disease Behavioral Risk Factors in Canadian Children and Adolescents. American Journal of Epidemiology, 170, 1279-1289.

[14]   Lowry, R., Wechsler, H., Galuska, D.A., Fulton, J.E. and Kann, L. (2002) Television Viewing and Its Associations with Overweight, Sedentary Lifestyle, and Insufficient Consumption of Fruits and Vegetables among US High School Students: Differences by Race, Ethnicity, and Gender. Journal of School Health, 72, 413-421.

[15]   Driskell, M.M., Dyment, S., Mauriello, L., Castle, P. and Sherman, K. (2008) Relationships among Multiple Behaviors for Childhood and Adolescent Obesity Prevention. Preventive Medicine, 46, 209-215.

[16]   Atkin, A.J., Gorely, T., Biddle, S.J.H., Marshall, S.J. and Cameron, N. (2008) Critical Hours: Physical Activity and Sedentary Behavior of Adolescents after School. Pediatric Exercise Science, 20, 446-456.

[17]   Dietz, W.H. and Strasburger, V.C. (1991) Children, Adolescents, and Television. Current Problems in Pediatrics, 21, 8-31.

[18]   DuRant, R.H., Baranowski, T., Johnson, M. and Thompson, W.O. (1994) The Relationships among Television Watching, Physical Activity, and Body Composition of Young Children. Pediatrics, 94, 449-455.

[19]   Robinson, T.N., Hammer, L.D., Wilson, D.M., Killen, J.D., Kraemer, H.C., Hayward, C. and Taylor, C.B. (1993) Does Television Viewing Increase Obesity and Reduce Physical Activity? Cross-Sectional and Longitudinal Analyses among Adolescent Girls. Pediatrics, 91, 273-280.

[20]   Sanchez, A., Norman, G.J., Sallis, J.F., Calfas, K.J., Cella, J. and Patrick, K. (2007) Patterns and Correlates of Physical Activity and Nutrition Behaviors in Adolescents. American Journal of Preventive Medicine, 32, 124-130.

[21]   Zabinski, M.F., Norman, G.J., Sallis, J.F., Calfas, K.J. and Patrick, K. (2007) Patterns of Sedentary Behavior among Adolescents. Health Psychology, 26, 113-120.

[22]   Cooper, M.L., Wood, P.K., Orcutt, H.K. and Albino, A. (2003) Personality and the Predisposition to Engage in Risky or Problem Behaviors during Adolescence. Journal of Personality and Social Psychology, 84, 390-410.

[23]   Waldvogel, J.L., Rueter, M. and Oberg, C.N. (2008) Adolescent Suicide: Risk Factors and Prevention Strategies. Current Problems in Pediatric Adolescent Health Care, 38, 110-125.

[24]   Edington, D.W. (2001) Emerging Research: A View from One Research Center. American Journal of Health Promotion, 15, 341-349.

[25]   Johnson, S.S., Paiva, A.L., Cummins, C.O., Johnson, J.L., Dyment, S.J., Wright, J.A., et al. (2008) Transtheoretical Model-Based Multiple Behavior Intervention for Weight Management: Effectiveness on a Population Basis. Preventive Medicine, 46, 238-246.

[26]   Pobutsky, A.M., Hirokawa, R., Zou, L., Huang, T., Rosen, L. and Wood, B. (2006) Overweight and At-Risk for Overweight among Hawai’i Public School Students Entering Kindergarten, 2002-2003. Hawaii Medical Journal, 65, 283- 287.

[27]   Mackun, P., Wilson, S., Fischetti, T. and Goworowska, J. (2011) Population Distribution and Change: 2000 to 2010. U.S. Census Bureau: 2010 Census and Census 2000.

[28]   Baruffi, G., Hardy, C.J., Waslien, C.I., Uyehara, S.J. and Krupitsky, D. (2004) Ethnic Differences in the Prevalence of Overweight among Young Children in Hawaii. Journal of the American Dietetic Association, 104, 1701-1707.

[29]   Grandinetti, A., Chang, H.K., Theriault, A. and Mor, J. (2005) Metabolic Syndrome in a Multiethnic Population in Rural Hawaii. Ethnicity & Disease, 15, 233-237.

[30]   Ye, J., Rust, G., Baltrus, P. and Daniels, E. (2009) Cardiovascular Risk Factors among Asian Americans: Results from a National Health Survey. Annals of Epidemiology, 19, 718-723.

[31]   Braun, K.L. and Nichols, R. (1997) Death and Dying in Four Asian American Cultures: A Descriptive Study. Death Studies, 21, 327-359.

[32]   Finucane, M.L. and McMullen, C.K. (2008) Making Diabetes Self-Management Education Culturally Relevant for Filipino Americans in Hawaii. The Diabetes Educator, 34, 841-853.

[33]   Javier, J.R., Huffman, L.C. and Mendoza, F.S. (2007) Filipino Child Health in the United States: Do Health and Health Care Disparities Exist. Preventing Chronic Disease, 4, 1-20.

[34]   Hawaii State Department of Education (2010) System Evaluation and Reporting Section, Systems Accountability Office, Office of the Superintendent November 22, 2010, Honolulu.

[35]   Geller, K.S. and Alvarez, A.R. (2012) The Health Action and Research Training (HART) Project: Filipino and Native Hawaiian Youth-Led Health Research in Hawaii. Proceedings of Society of Behavioral Medicine (SBM) Conference, New Orleans, 11-14 April 2012.

[36]   Strong, W.B., Malina, R.M., Blimkie, C.J., Daniel, S.R., Dishman, R.K., Gutin, B., et al. (2005) Evidence Based Physical Activity for School-Age Youth. The Journal of Pediatrics, 146, 732-737.

[37]   US Department of Health and Human Services & Department of Agriculture (2005) Dietary Guidelines for Americans, 2005. 6th Edition, US Government Printing Office, January 2005, Washington DC.

[38]   Gebhardt, S.E., Lemar, L.E., Pehrsson, P.R., Exler, J., Haytowitz, D.B., Showell, B.A., et al. (2010) USDA National Nutrient Database for Standard Reference, Release 23.

[39]   Laaksonen, M., Prattala, R. and Lahelma, E. (2003) Sociodemographic Determinants of Multiple Unhealthy Behaviours. Scandinavian Journal of Public Health, 31, 37-43.

[40]   Schuit, A.J., van Loon, A.J.M., Tijhuis, M. and Ocké, M.C. (2002) Clustering of Lifestyle Risk Factors in a General Adult Population. Preventive Medicine, 35, 219-224.

[41]   Lawlor, D.A., O’Callaghan, M.J., Mamun, A.A., Williams, G.M., Bor, W. and Najman, J.M. (2005) Socio-economic Position, Cognitive Function, and Clustering of Cardiovascular Risk Factors in Adolescence: Findings from the Mater University Study of Pregnancy and Its Outcomes. Psychosomatic Medicine, 67, 862-868.