HEALTH AND ITS DETERMINANTS - neurocentrum.pl · Wydział Zdrowia Publicznego w Bytomiu Śląski Uniwersytet Medyczny w Katowicach Department of Cancer Prevention School of Public

HEALTH AND ITS DETERMINANTS

CHAPTER XI

Zakład Profilaktyki Chorób Nowotworowych

Wydział Zdrowia Publicznego w Bytomiu

Śląski Uniwersytet Medyczny w Katowicach

Department of Cancer Prevention

School of Public Health in Bytom

Medical University of Silesia in Katowice

*Emergency Medicine Department of Child Neurosurgery

and Emergency Medicine Clinic

School of Public Health in Bytom


*Katedra Neurochirurgii Dziecięcej i Medycyny Ratunkowej

Zakład Medycyny Ratunkowej

Wydział Zdrowia Publicznego w Bytomiu


** Department of Orthopaedics of Saint Barbara Hospital in Sosnowiec

School of Medicine with the Division of Dentist in Zabrze


** Oddział Kliniczny Ortopedii Szpitala im. Św. Barbary w Sosnowcu,

Wydział Lekarski z Oddziałem Lekarsko-Dentystycznym w Zabrzu


MAŁGORZATA OLEJNICZAK-NOWAKOWSKA,

KAROLINA KRUPA-KOTARA, DARIUSZ MYRCIK*,

MAGDALENA TRZEPIZUR**, JOANNA MAKARSKA*,

ANNA ŁUKASIK, AGATA ZYCH*

Health Behaviour of The Secondary School Students in Silesia

Zachowania zdrowotne uczniów szkół gimnazjalnych

w województwie śląskim

Key words: health behaviour, students, health, secondary school, Silesia

Słowa kluczowe: zachowania zdrowotne, uczniowie, gimnazjaliści, województwo

śląskie


146

INTRODUCTION

Teenagers' lifestyles have undergone significant changes over the years under

the influence of growing technology and the availability of drugs. Since the begin-

ning of the 20th century, the hierarchy of values in society has changed. Modern

adults are increasingly paying a special attention to an individual and a career devel-

opment, which often results in the decision to start a family and to have children.

Consequently, it has an influence on the increase of the risk of an improper or an

insufficient transmission of patterns of health behaviour.

Family is a basic functional element in education, prevention and promotion

of health, where the key information concerning hygienic, nursing habits and priori-

ty information on health determinants are transmitted. The family, as the smallest

social unit, creates its pro- and anti-health behaviour among the youngest family

members. In family settings, people form the ways to deal with illness, especially by

symptom analysis and tendency to treatment or self-medication [12].

A puberty is an important stage in every person's life. Although the young person

has already enduring health-related habits, however psychology and personality are

shaped in this period. A pro-health education can be “the last chance” for a change

or a creation of proper health attitudes at this stage of life. Decisions of young peo-

ple concerning their behaviour and attitudes to health are often causes by their lack

of knowledge or skills.

Therefore, shaping proper priorities and educating teenagers about the conse-

quences of their actions are visible after many years.In the source literature concern-

ing a pro-health behaviour we include: a lifestyle, the characteristic of juvenile peri-

od and defining health. In everyday language a lifestyle functions as a concept iden-

tical to the way of life, patterns of behaviour, cultural patterns, values or attitudes.

The lifestyle, in specialist literature, also has many meanings, which affects the

difficulty in defining it [10]. According to Sicinski, the lifestyle is "a set of daily

behaviour that are specific to a given community or entity, characteristic way of

being distinct from a given community or entity, or a more or less a consciously

adopted life strategy." The World Health Organization, referring to the most widely

used definition of the Milo Teachers, indicates that lifestyle is "patterns of behavior-

al choices among the alternatives available to people according to their socioeco-

nomic situation and the ease with which they can translate certain behaviour into

others" [11].

A human health is determined by many factors, which undoubtedly belong to the

lifestyle. In Cendrowski's "Decalogue of a Healthy Lifestyle," attention is paid to

adhering to several key principles that can affect the right way of life:

Knowledge of yourself,

Maintaining the body's defenses in a constant readiness,

Do not abuse drugs,

Maintaining comprehensive physical activity,

Małgorzata Olejniczak-Nowakowska, Karolina Krupa-Kotara, Dariusz Myrcik,

Magdalena Trzepizur, Joanna Makarska, Anna Łukasik, Agata Zych


147

Proper nutrition,

Hardening,

Developing the skills to fight with the distraction,

Eliminate addictions,

Kindness to others,

Behaviour coping.

Health behaviour, also known as behaviour connected with health, are all the be-

haviour (or activities) of individuals that is part of them or their daily lifes and influ-

ences their health, the actions of practicing the knowledge of health and illness.

They are the subjects of relatively free and individual choices and decisions. This is

the part of the health determinants that everyone has control over it [7]. The follow-

ing health behaviors can be distinguished:

bio-positive, otherwise healthy, having a positive effect on health, aiming at

or sustaining, strengthening, restoring health and fitness;

bionic, otherwise anti-health, negatively related to health, causing harm, dis-

ease or impairment, adversely affecting health, making prevention difficult,

early diagnosis, delaying treatment and rehabilitation [7].

According to Lucyna Narojek, a dietary behaviour "dependents on various fac-

tors of action and ways of meeting the needs of nutrition. Dietary behaviour are not

just a response to the physiological need for hunger. Storing of food leads to the

need for food safety. Food can be a symbol of gratitude and joint eating improves

relationships between loved ones. Nutritional behaviors can be analyzed on many

levels: as consumer behaviors, as an element of culture related to the culture of tra-

dition, the recognition of values, observance of religious or secular norms; Finally,

as an important area of health behavior in the context of reflection and research in

the areas of health psychology, health promotion and health education" [13].

The teenager's diet usually differs from the general standard for this developmen-

tal period. Youth period is a key stage of life, and proper nutrition is indispensable

for proper development.The Ministry of Health indicates that physical activity inc-

ludes all physical activity and movement (muscle work), which accelerate heart and

breathing, and there is also a feeling of warmth. These are, in particular, physical

exercises (sports) and daily activities (walking, cycling). " According to Woynarow-

ska "physical activity, combined with healthy nutrition, is one of the basic human

needs and a key condition for preserving and enhancing health in all periods of life."

The Ministry of Health has developed recommendations for daily physical activity

that should be done for at least 60 minutes in a variety of forms, such as walking,

taking stairs, individual and team sports, physical education, morning gymnastics,

walking on foot [2, 6].

Contemporary lifestyles and the development of modern technologies have con-

tributed to less active lifestyle [9]. Many people forget that exercising physical ac-

tivity at an early age is beneficial for the functioning of the body.


148

Personal hygiene is considered to be a pro-healthy behaviour that is acquired

from an early age. The issue of hygiene is not only related to aesthetics and to the

perceptions of others, but to the elimination of germs, viruses, bacteria and other

dangerous health factors. This includes washing the body, hair and teeth, changing

clothes and underwear.

Skin is a protective barrier of the internal environment of the body against va-

rious external factors: physical, chemical or biological.

The source of the energy needed for daily living is to satisfy the need for sleep. It

is necessary to sleep at least once a day for a proper functioning. Dream, until the

50s of last century, was considered as a phenomenon that lasts all night and which is

not accompanied by any thought, and consequently, is not worthy of any scientific

research. Later on, the movement of the knobs and dreams contributed to the con-

centration of a sleep. Currently, knowledge about a sleep is much greater. Research

on this state may find use in creating a pattern of sleep [16].

It is necessary to cycle through the normal and active phase (REM) for proper

sleep quality. They are characterized by different physiological parameters, especial-

ly in terms of brain activity. The first phase of sleep, just after fallings sleep, is a

normal, deep, cyclical sleep that goes into an active, flat sleep, whose periods beco-

me longer in the late hours of the night. Hence, it is believed that sleep before

midnight is more valuable than sleep in the early morning [9].

AIM OF THE WORK

The main aim of the reasearch was to analyze health behaviour among junior

high school students. The specific aim was to determine what, according to junior

high schoolers, is part of health-promoting behaviour. Another specific goal was to

check the ways how people spend their free time and to determine the participation

of students in physical education classes. The next goal was to evaluate the behav-

iour and eating habits of the respondents, and their attempts to try to lose weight.

Another aim was to establish the personal hygiene habits of the subjects, such as

washing the whole body, hands and teeth. The last specific aim was focused on how

many hours the students spend on sleep.

MATERIAL AND METHODS

The study was conducted among 300 high school students. There were 150 girls

(50%) and 150 boys (50%). The age of respondents ranged from 12 to 16 years.

A self-generated questionnaire was the research tool used in the study. The ques-

tionnaire was conducted among pupils of the gymnasium in the Silesian province.

The questionnaire was anonymous, consisted of 38 questions and was divided into

two parts. The first part contained questions about demographic information: gender,

age, place of residence, and anthropometrics information: height, weight. The sec-

ond part consisted of 32 open and closed questions related to physical activity, rec-

reation, personal hygiene and sleep. Based on the information received from the

survey, a database was created in Microsoft Office Excel 2013 and Statistica 12. The




149

results were presented in the form of figures and tables. Quantitative and qualitative

data were analyzed using the χ2 test.

Fig. 1. Health behaviour promoting health

Among all the group of the respondents, the highest number of researchers indi-

cated a physical activity as a normal health behaviour - 78 healthy people (26%).

Least students indicated frequent hand washing - 27 people (9%). The students ,who

identified all the health behaviour listed in the questionnaire, consisted of 25% of the

survey group.

By further analysis of the statistical responses of the respondents on the interpre-

tation of health behaviour, respondents were divided according to the middle school

class. Chi Pearson's Chi2 test demonstrated a statistically significant relationship

between the middle school class and the appropriate amount of sleep as a health

promoting behaviour.


150

Fig. 2. Preferred physical activity

Team games are approved physical activities among students - 81 people.

Another form of activity selected by the respondents is a walk - 63 people. Cycling

was the least favourite activity - 3 people.

Analyzing the relationship between the middle school and the preferred physical

activity, the Chi2 Pearson Test showed a statistically significant relationship betwe-

en the middle school and team games as the preferred form of physical activity.

Significance level p <0.05.

Fig. 3. Participation in additional mobility activities




151

Among the students participating in the study, 114 people participate in addi-

tional activities. In contrast, 117 people do not participate in this type of activity,

while 21 respondents think that they do not have time for it.

Fig. 4. Reasons for a lack of active participation in physical education classes

Most pupils always attend physical education classes - 135 people. On the other

hand, the most common cause of non-participation in physical education classes,

indicated by respondents, is sickness due to health problems - 117 people.

Fig.5 Activities performed by students in their spare time

Most pupils meet with friends in their free time - 21% of the respondents, and

listen to music - 18%. At the same time, 9% of students do sports, 6% prefer active


152

recreation and 3% prefer sleeping. Participation in different courses is declared by

1% of the respondents.

Analyzing the relationship between free time activities and the middle school

class, Chi2 Pearson's Chi2 test showed a statistically significant relationship be-

tween middle school and reading books in free time. Significance level p <0.01;

Chi2 = 10,412.

Fig. 6. Attempted weight loss among the students

Among the surveyed students, 54% indicated that they have never been on a diet

because there was no need. At least 5% of the respondents have never ever lost we-

ight despite being overweight / obese. In contrast, 21% of the respondents declared

dieting attempts, giving the reasons: fashion, the pressure of peers, identifying

themselves as overweight or obese.

Meals, except the afternoon tea, are consumed most of the day. The first bre-

akfast is eaten several times a week in the case of 23% of the respondents. 15%

people do not consume the second breakfast, but it is consumed several times a

week by 27% of the students. Dinner is the most commonly eaten meal during the

day - 89%.

By further analyzing the most commonly consumed meals according to the lower

secondary school, Chi2 Pearson Test was used, however, it did not show a statisti-

cally significant relationship between the middle school class and the frequency of

intake of individual meals.

The second breakfast is consumed by students mostly at school, the rest of the

meals are usually consumed at home; 35% of the respondents prefer breakfast san-

dwiches and 24% prefer fruits or vegetables. In contrast, 12% of the students eat

sweets or fast food for the second breakfast.

Most students do not buy breakfast, but bring it from home - 81%. On the other

hand, if they buy them, the most common place to buy breakfast products is the




153

housing market - 13%. The respondents declare that they do not buy breakfast in the

school vending machine.

The respondents frequently drink water - 65% of people. Energy drinks and

coffee are drunk the least .

By analyzing the most commonly consumed drinks, the answers were divided

according to the middle school class. The Chi2 Pearson Test, which showed a stati-

stically significant relationship between the middle school class and the frequency of

consumption of carbonated beverages (p <0.01) and juices (p <0.01). Consequently,

fizzy drinks are most commonly drunk by first-graders, while juices from second-

graders.

DISCUSSION

Youth health behaviour are important factors influencing the development of the

young organism, which will determine future health habits. Habits practiced at a

later time can have negative or positive effects on health, both on individuals and

future generations.

From own research, it is cleared that young people are able to interpret healthful

behaviour in a satisfactory way. Physical activity was the most important factor

indicated by young people. In the studies of Bednarek and Chmielewska 93.2% of

girls and 88.4% of boys considered personal hygiene as the most important factor

determining health [8]. There is no coherent relationship between knowledge, health

consciousness and daily health promoting behaviour because health is the subject of

reflection for 95.5% of the surveyed girls and boys, but the meditations are a deter-

minant of health behaviour only for 29 5% of people [3].

Fashion to a slim silhouette has receantly increased. It encourages youth to seek

weight reduction in order to improve their appearance. Own research has shown that

more than half of the respondents did not try to lose weight. Another American

study was conducted by Dixon-Works and WPS, where more than half of girls and

29% of boys are constantly trying to lose weight [1]. According to the WHO report,

15% of eleven-year-olds, 22% of thirteen-year-olds and 27% of 15-year-olds are on

diet in Poland [4,18].

Our own research shows that 45% of junior high school students participating in

the study always participate in physical education classes. The most frequent reason

for lack of active participation in physical education classes was medical discharge

due to health problems (39%). The worrying number of respondents (16%) do not

practice physical education classes because of their unwillingness to learn. In the

studies Wojtyła et al. 96% of students participate in physical education classes. In

these studies, the main reason for not attending sports classes was long-term medical

discharge [4]. Woynarowska reports that 73.8% of pupils participated in all or al-

most all physical education classes in the 2012/2013 school year. The problem of

low physical activity and its health consequences are increasingly affecting children

and adolescents. The results of the research, conducted in Poland between 1979 and

1999, indicated a marked decrease in the physical fitness of adolescents. The main

cause of this condition was watching television [18]. This trend has been confirmed


154

by Dudek et al., Where between 1998 and 2010 physical activity among boys de-

creased by almost 20%, while among girls by 15%. The main reason of it is the

rapid increase of the time spending in front of the computers [14].

CONCLUSIONS

1. Middle school students properly interpret healthy behaviour and physical activity

as the most common behaviour of this type.

2. High school students ominously spend a lot of free time on watching TV and

computer games during the day. Most students in their spare time prefer passive

activities, for example: meeting with friends, listening to music, and playing

computer games.

3. Most of the respondets participate in additional mobility activities. The majority

of junior high school students actively participate in physical education classes at

school, but the most common reason for not attending these classes is a medical

leave.

4. A significant percentage of the respondents eat meals at home while the main

product preferred by the students for the second breakfast are sandwiches. Most

of the respondents did not try to lose weight in the past.

5. A significant majority of the respondents, practicing day and night toilets in the

morning, identify them mainly and only with face and hands washing.

6. Most junior high school students brush their teeth twice a day. Hand washing is

usually done after using the toilet, after returning home and always before eating.

7. Most middle school students devote more than 7 hours for a night sleep, ho-

wever, a significant percentage of the respondents devote less than 6 hours for a

sleep.

REFERENCES

1. Bednarek A. and E. Chmielewska. Knowledge of school youth on health. Gene-

ral Medicine and Health Sciences, 2013, 19(4): 469–474.

2. Buczak A. Nutritional behavior of adolescents in the perspective of health educa-

tion. Lublin: Marii Curie-Skłodowskiej University Publishing House; 2014.

3. Caldwell J. Sen. Poznań: REBIS publishing house; 2006.

4. Dixon-Works D, Nenstiel RO and Z.Aliabadi. Common Eating Disorders: A

Primer for Primary Care Provides – Board Review. Clin Rev 2003, 13(9): 882-

896.

5. Dudek M, Kasznia-Kocot J. and K. Giel. Trends of selected health behaviors of

Polish youth aged 13-15 the European and worldwide studies between 1995-

2011. Environmental Medicine, 2015, 18(2): 74-80.




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6. Langley – Evans S. Nutrition and Adolescence . [In:] Langley – Evans S. Noutri-

tion, Health and Disease: A Lifespan Approach. Warsaw: Lekarski Publishing

House, 2013: pp: 150 – 175

7. Ostrowska A. Healthy lifestyles. [In:] Lifestyle from health issues of health pro-

motion.

8. Ostrowska A. Realization of a healthy lifestyle in Poland. [In:] Lifestyle and

health from issues of health promotion. Warsaw: IFiS PAN Publishing; 1999:

pp: .33-120.

9. Physical activity and sport. http://www.mz.gov.pl/zdrowie-i-

profilaktyka/zdrowie-matki-i-dziecka/zdrowie-ucznia/aktywnosc-fizyczna-i-

sport, date of access: 2016-03-12

10. Ponczek D. and I. Olszowy. The lifestyle of youth and its impact on health

11. Probl Hig Epidemiol 2012, 93(2): 260-268.

12. Skórzyńska H. Medical care over the family in health and illness. [In:] Kulik T,

Pacian A. Public Health. Warsaw: Lekarski Publishing House PZWL; 2014: pp:

332-358.

13. Warsaw: IFiS PAN Publishing ; 1999: pp:13-32.

14. Wojtyła A, Bliński P, Bojar I. and K. Wojtyła. Physical Activity Among Junior

High School Adolescents in Poland. Probl Hig Epidemiol 2011, 92(2): 335-342.

15. Wojtyła A, Kapka – Skrzypek L, Paprzycki P, Diatczyk J, and J. Bylina. Adole-

scents` Health-Related Behaviour. Report. Lublin: WSI Medical Institute; 2011.

16. Woynarowska B. A Health Education. Warsaw: PWN Publishing House ; 2008.

17. Woynarowska B, Mazur J. and J. OblacińskaParticipation of students in physical

education lessons in schools in Poland. Hygeia Public Health 2015, 50(1): 183-

190.

18. Zięba – Kołodziej B. On the Margins of Health or About Heath-Related Be-

haviours of the Secondary School Young People. Medical News, 2012, 81(4):

330–336.

19. Żołnierczuk – Kieliszek D. Health behaviors and their relationship to health.

[In:] Kulik T, Pacian A. Public Health. Warsaw: Lekarski Publishing House

PZWL; 2014: pp: 64-87.

ABSTRACT

A human health is determined by many factors, which undoubtedly belong to the

lifestyle. In Cendrowski's "Decalogue of a Healthy Lifestyle," attention is paid to

adhering to several key principles that can affect the right way of life. The main aim

of the research was to analyze health behaviour among junior high school students.

The specific aim was to determine what, according to junior high schoolers, is part

of health-promoting behaviour. Another specific goal was to check the ways how


156

people spend their free time and to determine the participation of students in physi-

cal education classes. The next goal was to evaluate the behaviour and eating habits

of the respondents, and their attempts to try to lose weight. Another aim was to es-

tablish the personal hygiene habits of the subjects, such as washing the whole body,

hands and teeth. The last specific aim was focused on how many hours the students

spend on sleep. The study was conducted among 300 high school students. There

were 150 girls (50%) and 150 boys (50%). The age of respondents ranged from 12

to 16 years. A self-generated questionnaire was the research tool used in the study.

Middle school students properly interpret healthy behaviour and physical activity as

the most common behaviour of this type. High school students ominously spend a

lot of free time on watching TV and computer games during the day. Most students

in their spare time prefer passive activities, for example: meeting with friends, lis-

tening to music, and playing computer games. Most of the respondets participate in

additional mobility activities. The majority of junior high school students actively

participate in physical education classes at school, but the most common reason for

not attending these classes is a medical leave. A significant percentage of the re-

spondents eat meals at home while the main product preferred by the students for the

second breakfast are sandwiches. Most of the respondents did not try to lose weight

in the past. A significant majority of the respondents, practicing day and night toilets

in the morning, identify them mainly and only with face and hands washing. Most

junior high school students brush their teeth twice a day. Hand washing is usually

done after using the toilet, after returning home and always before eating. Most

middle school students devote more than 7 hours for a night sleep, however, a sig-

nificant percentage of the respondents devote less than 6 hours for a sleep.

STRESZCZENIE

Zdrowie człowieka determinowane jest przez wiele czynników, do których nie-

wątpliwie należy styl życia. W „Dekalogu zdrowego stylu życia” Cendrowskiego

zwraca się uwagę na przestrzeganie na kilku kluczowych zasad, które mogą wpłynąć

na właściwy styl życia. Głównym celem badania była analiza zachowań zdrowot-

nych wśród gimnazjalistów. Celem szczegółowym było ustalenie co według gimna-

zjalistów wchodzi w skład zachowań zdrowotnych sprzyjających zdrowiu. Kolej-

nym celem szczegółowym było sprawdzenie sposobu spędzania wolnego czasu

przez ankietowanych oraz ustalenie uczestnictwa uczniów w zajęciach wychowania

fizycznego. Następnym celem było ocenienie zachowań i nawyków żywieniowych

wśród badanych oraz podejmowania przez nich próby odchudzania się. Kolejnym

celem było ustalenie nawyków dotyczących higieny osobistej badanych, takich jak:

mycie całego ciała, rąk oraz zębów. Ostatnim celem szczegółowym było sprawdze-

nie, jaka ilość godzin poświęcana jest przez uczniów na sen. Badanie zostało prze-

prowadzone wśród 300 uczniów gimnazjum. Wśród badanych było 150 dziewcząt

(50%) i 150 chłopców (50%). Wiek ankietowanych mieścił się w przedziale od 12

do 16 lat. Narzędziem badawczym zastosowanym w badaniu był kwestionariusz

ankiety autorstwa własnego. Gimnazjaliści odpowiednio interpretują prawidłowe

zachowania zdrowotne, a aktywność fizyczna stanowi najczęstsze wskazywane




157

zachowanie tego typu. Gimnazjaliści niepokojąco dużo wolnego czasu w ciągu dnia

przeznaczają na oglądanie telewizji i gry komputerowe. Większość uczniów w

wolnym czasie preferuje bierny wypoczynek, do którego zalicza: spotkania ze zna-

jomymi, słuchanie muzyki, a także granie w gry komputerowe. Większość uczniów

objętych obserwacją uczestniczy w dodatkowych zajęciach ruchowych. Stanowcza

większość gimnazjalistów czynnie uczestniczy w zajęciach wychowania fizycznego

w szkole, natomiast najczęstszym powodem nie uczestniczenia w tych zajęciach jest

zwolnienie lekarskie. Znaczący odsetek badanych spożywa posiłki w domu nato-

miast głównym produktem preferowanym przez uczniów na drugie śniadanie są

kanapki. Wśród badanych większość nie podejmowała w przeszłości próby odchu-

dzania się. Znacząca większość badanych praktykując codzienną toaletę wieczorną

oraz poranną, utożsamia głównie i tylko z myciem twarzy oraz rąk. Większość gim-

nazjalistów myje zęby dwa razy dziennie. Mycie rąk jest zazwyczaj wykonywane

zawsze po skorzystaniu z toalety, po powrocie do domu oraz zawsze przed jedze-

niem. Gimnazjaliści w większość poświęcają na sen ponad 7 godzin na dobę, jed-

nakże znaczący odsetek poświęca na sen nocny mniej niż 6 godzin.

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