The forgotten age group: The need for targeted physical activity and healthy lifestyle promotion for older adolescents

Introduction
Globally, limited research has examined healthy lifestyle promotion for older adolescents (16–18 years), yet habitual healthy lifestyles can be developed at this time. Most initiatives have been aimed at adults or younger children and research has highlighted England to be up to ten tears behind other countries in prioritising health education (Berkman et al., 2010). This research aims to examine older adolescents’ knowledge and understanding of healthy lifestyle [nutrition and physical activity (PA)] recommendations and compare these to their self-reported PA, active transportation, active leisure and food intake. It will also ask their experiences of how healthy lifestyles are promoted to them.

Method
Ninety-three participants (39M; 54F) (M age=16.9, SD=.40 years), from 3 low socio-economic English high schools completed an online questionnaire on their self-reported: (1) daily physical activity (PA); (2) active transportation (AT); (3) active leisure time (AL); (4) food intake; (5) experiences of healthy lifestyles promotion; and (6) perceived healthiness. Questions were merged from both the validated Global Physical Activity Questionnaire (GPAQ) (WHO, 2004) and the Short Form Food Frequency Questionnaire (SFFFQ) (Cleghorn & Cade, 2017). To examine perceived healthiness, participants rated their overall health on a 5-point scale over the past 12 months. Daily PA, active transport, active leisure and how participants felt healthy lifestyles were promoted to them, were asked via open-ended questions. The SFFFQ was used to generate a food group score [via the Diet and Nutrition Tool for Evaluation (Cleghorn & Cade, 2017)], which were then added together to create an overall diet quality score (DQS).
Data analysis was undertaken within SPSS 24.0 (IBM Corp, Armok, NY, USA). A multi-variance of statistical analysis (MANOVA) assessed group differences across multiple dependent variables of the food group scores and overall DQS. GPAQ questions were analysed individually according to demographics: sex, and perceived healthiness. Univariate analysis of variance (ANOVA) was then undertaken for each question to assess the group differences per element of PA. Thematic analysis was used to analyse all open-ended questions. Statistical significance was set at <.05.

Results
Only 60% reached PA recommended guidelines. Yet, 92% (n=86) used active travel for a least 10 mins continuously; of these, 86% (n=80) undertook this at least 5 days per week. Over half (51%, n=47) undertook MVPA as active leisure. However, 66% (n=61) spent ≥5 hours sedentary and only 17% (n=16) met recommended nutritional guidelines for health. Males who rated themselves as having poor health had eaten the recommended intakes of fat (1.00±.00), compared to females who rated themselves as having poor health but ate more than the recommended intakes of fat (2.60±.89). Nearly all participants (90%, n=80) did not report school as a place that promoted healthy lifestyles.

Discussion
As a public health measure and an educational policy matter, it is recommended schools implement more targeted PA and healthy eating initiatives for older adolescents. Further research is also needed to examine male older adolescents’ health literacy to get a deeper insight into their understanding and application of information relating to their health.

References
Berkman, N. D., Davis, T. C., & McCormack, L. (2010). Health literacy: what is it? Journal of Health Communication, 15(S2), 9-19.
Cleghorn, C., & Cade, J. (2017). Short Form Food Frequency Questionnaire. Available online: https://www.nutritools.org/tools/
World Health Organization (2004). Global Physical Activity Questionnaire (GPAQ). World Health Organization. Geneva, Switzerland.