title: Clustering and correlates of multiple health behaviours in 9-10 year old children.
abstract: BACKGROUND
  Sleep, physical activity, screen time and dietary behaviours influence health during childhood, but few studies have looked at all of these behaviours simultaneously and previous research has relied predominantly on self- or proxy-reports of physical activity and food frequency questionnaires for the assessment of diet.
  
  
  OBJECTIVE
  To assess the prevalence and clustering of health behaviours and examine the socio-demographic characteristics of children that fail to meet multiple health behaviour guidelines.
  
  
  METHODS
  Data are from the Sport, Physical activity and Eating behaviour: Environmental Determinants in Young people (SPEEDY) study. Participants (n = 1472, 42.9% male) were dichotomized based on whether or not they met public health guidelines for accelerometer-assessed physical activity, diet-diary assessed fruit/vegetable intake and fat/non-milk extrinsic sugar (NMES) intake, and self-reported screen time and sleep duration. Behavioural clustering was assessed using an observed over expected ratio (O/E). Socio-demographic characteristics of participants that failed to meet multiple health behaviour guidelines were examined using ordinal logistic regression. Data were analysed in 2013.
  
  
  RESULTS
  83.3% of children failed to meet guidelines for two or more health behaviours. The O/E ratio for two behavioural combinations significantly exceeded 1, both of which featured high screen time, insufficient fruit/vegetable consumption and excessive fat/NMES intake. Children who were older (Proportional odds ratio (95% confidence interval): 1.69 (1.21,2.37)) and those that attended a school with a physical activity or diet-related policy (1.28 (1.01,1.62)) were more likely to have a poor health behaviour profile. Girls (0.80 (0.64,0.99)), participants with siblings (0.76 (0.61,0.94)) and those with more highly educated parents (0.73 (0.56,0.94)) were less likely to have a poor health behaviour profile.
  
  
  CONCLUSIONS
  A substantial proportion of children failed to meet guidelines for multiple health behaviours and there was evidence of clustering of screen viewing and unhealthy dietary behaviours. Sub-groups at greatest risk may be targeted for intervention.
authors.affiliation: Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands.
authors.forename: Leonie K
authors.initials: LK
authors.lastname: Elsenburg
authors.affiliation: Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands.
authors.forename: Eva
authors.initials: E
authors.lastname: Corpeleijn
authors.affiliation: Medical Research Council, Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
authors.forename: Esther M F
authors.initials: EM
authors.lastname: van Sluijs
authors.affiliation: UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Atkin
mesh_terms: D000886:Anthropometry; D002648:Child; D016000:Cluster Analysis; D003710:Demography; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors