The results suggest that this sample of adolescents presents a good Life Style, assessed by the Life Style Questionnaire. Although higher than 50%, the MS and NUT subscales were the subscales with a lower average score. With regard to SS, half of the sample has a highly elaborate repertoire and, as the literature indicates and was expected, the adolescents with the best LS are those with better SS repertoire [29]. In addition, a solution of three clusters was found where the cluster 3, the “Healthy”, was the biggest one and the cluster 2, the “Sociable” was the most in need of health education and promotion interventions.
Regarding the MS subscale, the item that assesses if adolescents travel with someone who drank too much was the one that presented lower values. This result may be related to the mean age of the present sample and not be a risk behaviour. However, it is worth to know that, in Portugal, the greatest occurrence of road accidents in motorized two-wheeled vehicles occurs mainly in male adolescents [31, 32] and, in European Union, the highest prevalence of deaths has been observed in male adolescents between the ages of 15 and 29 years [32]. In addition, one of the main causes of death and disability is alcohol consumption [32] and the injuries related to accidents or violent behaviors frequently associated with alcohol consumption are indicated as the major cause of death in childhood and adolescence (from 5 to 19 years) [33]. Although recent data suggest a decreasing trend in the prevalence of alcohol consumption in both sexes at age 15, it suggest an increase in 16-year-old female adolescents [34], emphasizing the urgent to need to address this major cause of death and disability in adolescents, especially if associated to driving behaviors. Fortunately, according to the most recent results of the Health Behaviour in School-aged Children in Portugal [30], from 6742 adolescents, most of them have never tried tobacco (93,7%), rarely use alcohol (90%), or drugs (96.1%), and 88.2% have reported never getting drunk.
Concerning NUT subscale, the item that evaluates the consumption of foods with sugar had the lowest average score, highlighting that a high proportion of adolescents do not avoid foods with sugar. These results are in line with the national scenario that, as demonstrated in the Health Behavior in School-aged Children study, more than half of the Portuguese adolescents who participated in the study, reported consuming sweets and soft drinks at least once a week and more than two-thirds said that sometimes ate unhealthy foods [35–38]. Despite the encouraging results of the present study, which highlight good LS in a representative sample of adolescents in the Tâmega and Sousa region, nutrition / food and monitored safety require greater investment in implementing health education and social skills programs given the positive relationship of SS with LS (ranging between r = .07 and r = .25 with p < .01 and p < .05).
Regarding the second objective of this study, the cluster analysis allowed to identify three groups of adolescents with different behavior profiles. One of the clusters identified was named “Adjusted” because the adolescents in it showed less elaborate SS repertoire but good indicators of LS. This group seems to have sufficient social skills to adopt good and healthy behaviors. The second cluster, was named “Sociable” because this group of adolescents showed high social abilities but some difficulties in adopt healthy and adequate LS regarding NUT and MS, suggesting a protective effect of SS [29]. The third cluster was called “Healthy” because it was the group of adolescents with highly elaborate repertoire of SS and with the healthier LS.
In addition, results showed that the NUT subscale was related to CIV skills, suggesting that the promotion of this social competence can, in turn, increase health awareness and health behaviors, especially with regard to diet and nutrient planning. Interestingly, no significant relationships were found between the MS subscale and SS. This result may be related with the age range of the sample and with the fact that these adolescents did not have legal age to drive yet (> 18 years old). However, among the MS behaviors evaluated in the questionnaire used in the study (“When I travel by car, I put my seat belt; I did not travel with a driver who drank too much; When I travel with someone, I like to maintain speed limits”), not travelling with a driver who drank too much, was the behavior reported with less frequency. It is noteworthy that this group of adolescents, designated by “Sociable”, was older than the group of adolescents in the “Adjusted” and “Healthy” clusters, but even so, ages ranged from 12 and 14 years old. Probably, the adolescents in this group are still too young to drive with friends. We also found that girls in this cluster practice less exercise compared to boys, as the literature indicates [9]. Knowing that levels of physical activity practice are below those recommended by WHO [37] this result emphasizes the need to promote the involvement of girls in physical activity. We did not find differences in LS according to age, which may be related to the homogeneity of the sample (70% of the sample of this cluster consists of adolescents between 12 and 14 years of age).
Limitations And Directions For Future Research
This study has some limitations that should be pointed out. The instruments used were self-reported and anthropometric data of adolescents, and demographic data of parents (such as age, socioeconomic status and household composition) were not collected. The study included only adolescents from the Tâmega and Sousa region, requiring a careful generalization of the findings. However, it is important to highlight that this region is characterized by a high prevalence of Tuberculosis [39] which, in addition to other factors, is also related to an unhealthy LS [40].
For future studies, we suggest an assessment of adolescents and their parents given the direct influence of parents’ LS in their children's LS [41, 42]. Moreover, White and Halliwell [43] found that adolescents’ perception of the mealtime environment contributes to family meals’ protective effect i.e. family meals were significantly associated with a lower likelihood of alcohol and tobacco use. In addition, parental styles should be evaluated; especially the parental style of the mother, since literature has been suggesting that it influences the children's adoption of high-risk behaviors [44]. The screen time consumption is a concern given the association with a reduced practice of physical activity [45] and future studies should control this variable. However, several studies have been showing an advantage of the use of text messages, internet programs and chats, apps (e.g. whats`app), as effective tools to instigate the behavior change in adolescents [46, 47]. This is, in fact, a controversial topic that needs further research.
Implications For Practice
This study reveals some implications for practice. In relation to the sample under study, we suggest regular health education sessions focused mainly on sugar intake behaviors, meal planning and travel safety with a driver who drink too much (i.e. social skills training), as well as promoting the involvement of girls in the practice of physical activity. Given that previous behavior is the best predictor of the intentions to adopt health behaviors, namely, having a balanced diet, practicing sports, not drinking alcohol and not smoking or taking drugs [48] we suggest that health education sessions should be implemented in a school context [49, 50]. There are several activities that could be included in the physical activity curriculum that would be more attractive for girls than football or volleyball. Thus, the promotion of healthy LS should be included in the school curriculum and be transversal to all academic disciplines.
In general, health education sessions should include factors that protect the adoption of risk behaviors, engage the main contexts of adolescent life, and address various health behaviors and target risk [35, 51]. The school context is in fact, privileged to carry out actions of this nature, but the inclusion and involvement of both adolescents and parents becomes fundamental. The promotion of a repertoire of SS that educates adolescents to a competent social style in LS choices is essential [52, 53]. Moreover, promoting emotional regulation as well as adaptive coping strategies is crucial for health promotion, especially in this population [54]. For example, self-regulation cognitions are positively related to healthy eating in adolescents [55]. Managing emotional regulation during class, conflict resolution, decision making, and choice may help adolescents in the adoption of health and protection behaviors. The most recent report of the study Health Behaviour in School-aged Children in Portugal [30], recommends the continued conduct of adolescent health programs, including sex education in schools, higher age limits for alcohol consumption, requiring seat belts and helmets, in order to promote healthier lifestyles in adolescents, prevent deaths and disability.