1. CABLE Child and Adolescent Behaviors in Long-term Evolution: A School-Based Health Lifestyle Study PI Lee-Lan Yen ( ) Szu-Hsien T. Lee ( ) Chuhsing K. Hsiao ( ) Ling-Yen Pan ( ) Wen-Chi Wu ( ) CABLE Research Team

2. Outline Background Study Design Work Completed in 2004 Work Will Be Conducted in 2005

3. Background Childhood is an important developmental stage. Early and successful interventions can improve children s health behaviors and health status. A lifestyle based study following the development of children and their health related behaviors has never previously been conducted in Taiwan.

4. Specific Aims To understand the status and types of health lifestyle among children. To investigate the developments and changes of children s health lifestyle over time. To explore the determinants of children s health lifestyle. To analyze the correlation between children s health lifestyle and health status.

5. Study Design (1) Cross-sectional Longitudinal Individual Family/Group Community/Society Changeability

6. Study Design (2) 2001 2010 Observational Follow-up -- Yearly Survey 2005

7. Study Design (3) A1-A6: The 1st cohort of Taipei from 2001-2006 B1-B6: The 1st cohort of Hsinchu from 2001-2006 C1-C6: The 2nd cohort of Taipei from 2001-2006 D1-D6: The 2nd cohort of Hsinchu from 2001-2006

8. Study Framework ~ Cross-Sectional Survey ~ Intrapersonal Factors Interpersonal Factors Organizational Factors Health Lifestyle Health Status

9. Independent Variables 1.Children & Parental Factors (demographics, health history, personal characteristics, etc.) 2.Family Factors (family structure, SES, etc.) 3.School & Community Factors (size, resources, etc.) 4.Other Factors (survey time, study area, etc.) Dependent Variables Health Lifestyle Health Status Intermediate Variables Interpersonal Factors Intrapersonal Factors Organizational Factors Time 1 Time i Time 1 Time i Time 1 Time i Time 1 Time i Time 1 Time i Study Framework ~ Longitudinal Follow-up ~

10. Study Subjects of Cohort 1 1 st grade 2 nd grade3 rd grade 2730 2576 94.0% -6.0% 93.0% -7.0%

11. Study Subjects of Cohort 2 4 th grade 5 th grade6 th grade 25102449 90.4% -9.6% 96.6% -3.4%

12. Study Instruments Questionnaires student parent teacher Documents student health record school profile community profile

13. Data Collection Intrapersonal Factors Interpersonal Factors Organizational Factors Health Lifestyle Health Status CABLE Questionnaires School & Community Profiles School Health Records

14. Field Survey, 2001-2003 Student name list Informed consent Subject name list Interviewer training Field Survey -- Children -- Parents 2001 & 2002 Subject name list 2003 Check name list Interviewer training Field Survey -- Children -- Parents

15. Field Survey, 2004 & 2005 Subject name list Rearrange name list Interviewer training Field Survey -- Children -- Parents Cohort 2 (Grade 7 & 8) Subject name list Check name list Interviewer training Cohort 1 (Grade 4 & 5) Field Survey -- Children -- Parents Mail Survey -- Children -- Parents

16. Data Management Coding, key in, and checking data Creating different data files Statistical analysis for specific purposes

17. Work Completed in 2004 Data collection & management Paper writing & publishing Results dissemination Professional training

18. Data collection teacher survey school profile community profile focus groups field & mail surveys Data management data files statistical analyses

19. Paper Writing & Publishing in 2004 Conference papers 2004 TPHA Annual Meeting (4 papers) 132 th APHA Annual Meeting (3 papers) 2005 Biennial Meeting of SRCD (1 paper) First Conference on Statistical Methodology (1 paper) Journal articles 1 paper published in Journal of Medical Science 4 papers submitted to domestic and international journals

20. Results Dissemination in 2004 Annual reports Annual Report 2002 has been published Annual Report 2003 is under preparation Reference for parents Application of CABLE questionnaires

21. Professional Training MasterDoctor 2001 2002 2003 2004

22. Work Will Be Conducted in 2005

23. Data Collection in 2005 Fifth graders (1st cohort) : Subjects: students + parents Field survey at 19 primary schools in 2 areas Eighth graders (2nd cohort): Subjects: students + parents Field Survey at 27 junior high schools + mail survey

24. Data Analysis in 2005 Cross-sectional data analyses Multiple / logistic regression Multilevel analysis Structural equation model, etc. Longitudinal data analyses Time series analysis Growth mixture model, etc.

25. Growth Mixture Model (GMM) (Muthen, 2004) Use both continuous and categorical latent variables to represent individual differences in development. Will be able to establish developmental typology of trajectories for child health lifestyle and also behavior problems.

26. The CABLE Project Website

27. Data Release Purpose: to maximize the contribution of the valuable CABLE datasets. A data-releasing guideline has been drawn- up in October, 2003. Three domestic researchers are working closely with CABLE research team currently. Connection with foreign scholars is building up.

28. 2nd CABLE Conference Will be held in early spring of 2005 Target audiences: Principles and teachers from study schools Officers from health and education departments Researchers and graduate students from academic institutes

29. CABLE Research Team Division of Health Policy Research, National Health Research Institutes Institute of Health Policy and Management, College of Public Health, National Taiwan University Department of Humanities and Social Sciences, National Defense Medical Center, National Defense University ~Thank You~

30. (1) Changes in Health- Related Behaviors Between 2001 and 2002 Among Two Child Cohorts of the CABLE Study Lee-Lan Yen, Ling-Yen Pan, Likwang Chen, Szu-Hsien Lee, Chuhsing Hsiao,

31. Major Findings Most of the positive health behaviors showed similar or increased rates over the two years. Decreased rates were only found in wearing a motorcycle helmet and brushing teeth before sleeping. The prevalence rates of performing negative health behaviors and the rates of children who changed to good or bad behaviors over the two years varied depending on the behavioral item, cohort, and area. Using vulgar language, drinking alcohol, and suicidal ideas are three problem behaviors with great potential in increase among children.

32. (2) The Influence of Family Interaction on the Initiation of Smoking Among Elementary Students in Taiwan Ling-Yen Pan, Lee-Lan Yen

33. Major Findings There were 3,961 students who completed the questionnaires both in 2001 and 2002. Regarding the initiation of cigarette smoking : New triers : 2.89% Continuous triers : 7.74% After controlling the children s and family s characteristics, those children with less family support and those receiving more punishment were more likely to be new triers.

34. Research Topics of Annual Report 2003 Lee-Lan Yen ( ): Change patterns of health behaviors from 2001 to 2003. Tony Szu-Hsien Lee ( ): Test-retest the validity and reliability of psychological instruments for CABLE study. Ling-Yen Pan ( ): Family interaction, parental psychological state and children s suicidal ideation: Results from CABLE cohort study. Wen-Chi Wu ( ): Effects of school and class factors on the 6th graders health behaviors in northern Taiwan: Results of CABLE study, 2003.

35. Master Theses Hung-Chieh Chang ( ): Social Capital of Family and School – Its Relationship with Children s Internalized Behavioral Problems. Jian-Tai Fu ( ): The Impact of Leisure Activities on Sleep Deprivation and Negative Behaviors among Sixth-Graders Playing Computer Games as An Example. Chi-Hsien Kao ( ): The Relationship between Childrens Depression and Family Interaction Types. Hsin-I Liu ( ): The Relationship Between Parent s Working Time and Children s Overweight and Obesity Among The Fifth Graders.

36. Social Capital of Family and School Its Relationship with Childrens Internalized Behavioral Problems Major Finding Those who are in lack of family social capital (low family interaction and high family conflict) and school social capital (low school identification) have more internalized behavioral problems. Besides, social capital might have more influence on girls than on boys. Master: Hung-Chieh Chang Advisor: Lee-Lan Yen

37. The Impact of Leisure Activities on Sleep Deprivation and Negative Behaviors among Sixth-Graders Playing Computer Games as An Example Major Finding The rates of children who playing PC games frequently and everyday are 21% and 9% respectively. Playing PC games was found to be associated with children s sleep deprivation and negative behaviors. Master:Jian-Tai Fu Advisor:Lee-Lan Yen

38. The Relationship between Children s Depression and Family Interaction Types Major Findings Children were more likely to be depressed when their mothers have had psychological problems or fathers have performed violent behaviors. Four types of family interaction: disciplinary, authoritative, supportive, and conflictive. Children from authoritative or conflictive families were more likely to be depressed. Master: Chi-Hsien Kao Advisor: Lee-Lan Yen

39. The Relationship between Parent s Working Time and Children s Overweight and Obesity Among Fifth Graders Major Findings Overweight: 11.8%(male); 10.5%(female) Obesity: 4.0%(male); 2.8%(female). Maternal working time (over 50 hrs/wk) was found to be associated with children s overweight. Master: Hsin-I Liu Advisor; Lee-Lan Yen Likwang Chen Likwang Chen