title: Clustering of health-related behaviors and their determinants: possible consequences for school health interventions.
abstract: Characterizing school health promotion is its category-by-category approach, in which each separate health-related behavior is addressed independently. Such an approach creates a risk that extra-curricular activities become overloaded, and that teaching staff are distracted by continuous innovations. Within the health promotion sector there are thus increasing calls for an integrative approach to health-related behaviors. However, a meaningful integrative approach to different lifestyles will be possible only if there is some clustering of individual health-related behaviors and if health-related behaviors have a minimum number of determinants in common. This systematic review aims to identify to what extent the four health-related behaviors smoking, alcohol abuse, safe sex and healthy nutrition cluster; and how their determinants are associated. Potentially modifiable determinants that offer clues for an integrative approach of school health-promotion programs are identified. Besides, the direction in which health educators should look for a more efficient instructional design is indicated.
authors.affiliation: TNO Quality of Life, P.O.Box 2215, 2301 CE, Leiden, The Netherlands. ch.wiefferink@pg.tno.nl
authors.forename: Carin H
authors.initials: CH
authors.lastname: Wiefferink
authors.forename: Louk
authors.initials: L
authors.lastname: Peters
authors.forename: Femke
authors.initials: F
authors.lastname: Hoekstra
authors.forename: Geert Ten
authors.initials: GT
authors.lastname: Dam
authors.forename: Goof J
authors.initials: GJ
authors.lastname: Buijs
authors.forename: Theo G W M
authors.initials: TG
authors.lastname: Paulussen
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking; D002648:Child; D016000:Cluster Analysis; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D009747:Nutritional Physiological Phenomena; D021841:Safe Sex; D012572:School Health Services; D012907:Smoking