TURKISH ARCHIVES of PEDIATRICS
Original Article
TÜRK PEDİATRİ ARŞİVİ
Health behaviors in high school students in İzmir, Turkey Sabanur Çavdar1, Esin Çetinkaya Sümer1, Kayı Eliaçık2, Aslıhan Arslan2, Begüm Koyun2, Nurhan Korkmaz2, Ali Kanık2, Ethem Erginöz2, Oya Ercan3, Müjgan Alikaşifoğlu3 Department of Public Health, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey Clinic of Pediatrics, İzmir Tepecik Training and Research Hospital, İstanbul, Turkey 3 Department of Pediatrics, Division of Adolescent Health, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey 1 2
Abstract Aim: The aim of this cross-sectional study was to determine the prevalence of the self reported health behaviors and differences in these behaviors by gender and grades in high school adolescents in İzmir, Turkey. Material and Methods: A stratified cluster sampling procedure was used for this cross-sectional study. The study sample included 2 296 students attending 22 high schools in Izmir. As a data collection instrument, some questions from the Health Behavior in School-aged Children Study 2009/2010 questionnnaire and questions which were developed by the researchers to understand behaviors of internet use in adolescents were used. Chi-square tests and Cramer’s V statistics were used for statistical analyses. Results: Among the high school students, 33.8% experimented smoking, 26.3% smoked cigarette during the 30 days before the survey, 14.9% smoked cigarette regularly during the 30 days before the survey, 54.1% experimented drinking alcohol, 38.4% drunk alcohol during the 30 days before the survey, 31.6% got drunk, 10.9% were adequately physically active, 59.9% watched TV for a long period of time, 72.8% used internet for a long period of time, 48.1% ate breakfast regularly, 36.2% ate adequate amount of fruit, 14.1% ate adequate amount of vegetable, 31.3% ate candies and chocolate very often, 18% drunk soft drink very often, 30.3% were bullied, 29.9% bullied others and 41% involved in a physical fight. Conclusions: These results showed that “Adolescent friendly health services” should be generalized all over Turkey, physicians should evaluate each adolescent for his/her health behaviors in each visit and implementation of prevention programs which adopt a health promotion perspective is necessary begining from the elementary school. (Turk Pediatri Ars 2016; 51: 22-34) Keywords: Alcohol, leisure time activities, adolescent, health behavior, violence, tobacco, eating behaviors
Introduction Adolescent is a Latin term which means “maturation by development” and expresses the period of transition from childhood to adulthood. This period which is also called puberty is a stressful and fluctuant period for the intividual and his/her connections during which many changes in terms of physical, cognitive, psychological and social aspects are experienced in association (1). Problems which may occur in one of the maturation processes may prevent healthy development in adolescents by affecting the other processes and cause to diseases which are also carried to adulthood (1, 2). The most important characteristic which is observed typically in adolescence is tendency to take risk. This tendency may cause to adoption of negative behaviors and attitudes related with health including use of tobacco, alcohol and substance which constitutes the ba-
22
sis for non-infectious diseases, unsafe sexual relation, consumption of nutrients with low nutritional value and high fat and calorie content and sedantary life-style or may render these behaviors and attitudes a life-style (2-5). These attitutes and behaviors may both affect the current health status of adolescents and cause to morbidity and mortality in adulthood (2, 3). For example, it is predicted that one fifth of adolescents aged 13-15 years smoke at the present time and approximately half of the individuals who smoke in adolescence will continue this behavior for at least 15 years more (2). The most important characteristic of the behaviors observed in adolescents which affect health adversely is that they are preventable to a large extent (5). Therefore, adolescence is considered an opportunity for preventing carriage of the behaviors which affect health adversely to adulthood (3). In addition, detailed information about health-related behaviors and diseases of adolescents is necessary in terms of accurate development of inter-
Address for Correspondence: Oya Ercan E-mail: [email protected] Received: 14.09.2015 Accepted: 13.11.2015 ©Copyright 2016 by Turkish Pediatric Association - Available online at www.turkpediatriarsivi.com DOI: 10.5152/TurkPediatriArs.2016.3389
Turk Pediatri Ars 2016; 51: 22-34
vention programs for both adolescence and childhood (3, 4). Another important point related with health-related behaviors in adolescents is that adolescents tend to exhibit multiple risky behaviors in association (6). The characteristic of the behaviors which may affect health adversely of clustering poses a risk of occurence of other behaviors in presence of one behavior, while it is an opportunity for interventions directed to one behavior to also prevent the others (6, 7). In our country in which the 15-19 age group constitutes 8.1% of the population, studies should be conducted in order obtain information about the health states of the young ones, their health-related behaviors and social and personal factors which lead to occurence of these behaviors, to evaluate the changes in these behaviors in time, to determine the priorities for programs which would be prepared to protect and develop the youngster’s health and to observe the effects of the interventions performed (8). In this cross-sectional study, it was aimed to determine the frequency of self-reported health-related behaviors of the young individuals who attended high school in Izmir, the distribution of these behaviors by gender and grade and the primary areas in adolescent health programs. Material and Methods This study constituted a part of a cross-sectional survey based on evaluation of a questionnaire form read and responded by students. This questionnaire form was designed to determine self-reported health states, health-related behaviors and the factors related with these behaviors in adolescents attending high school in Izmir. Two thousand two hundred ninety six students who attended 22 high schools in Izmir were included in the study. Ethics committee approval was obtained from the Tepecik Education and Research Hospital Ethics Committee (meeting dated 09.30.2014,decision number: 10) and the necessary approval was obtained from the Izmir provincial directorate for national education (article dated 12.10.2014 with number 6297744). Sample selection Stratified cluster sampling method was used for selection of the sample. The sampling unit was accepted to be “school”. The high schools were considered as two strata including general high schools and vocational high schools according to the type of education. The 2013/2014 academic year of İzmir Provincial Directorate for National Education data were used to frame the study population. Private high schools and
Çavdar et al. Health behaviors in adolescents
private area high schools were excluded from the study. The students in the high schools which were excluded constituted 69% of the population. Conclusively, the population was established as 193 370 students including 86 275 students studying at general high schools and 107 095 students studying at vocational high schools. The sample was calculated with 95% confidence interval, 80% power and 2% margin of error. Each stratum and each class was represented in the sample with its ratio inside the population and the sample size was determined to be 2 062 students with corrections including stratum, classroom and rounding. The design effect was calculated to be 1.28. It was thought that the high school students obtained from this sample would represent the young individuals attending high school in the province of İzmir. The classes for which the questionnaire form would be applied were determined by drawing lots at the level of district, school and class. It was taken care of that at least one general high school and one vocational high school were included in each district. The questionnaire form was applied to studets who were present on the day of application and who volunteered to participate in the study in the classes which were chosen by lot. The application was performed in a total of 101 classes in 22 schools. Data collection tools used in the study A questionnaire form composed of two parts was used as data collection tool in this study. The first part consisted of 37 questions. These questions were obtained from the international questionnaire form belonging to an international survey named “Health Behaviour in School-aged Children Study-2009/2010 (HBSC 2009/2010)” (9). The questions related with gender, class, age, eating habits, dieting, physical activity, use of tobacco and alcohol, state of well-being, body weight, height, health complaints, body image, bullying, socioeconomical status, school life and family structure were selected from this questionnaire form. Since the conducters of the Turkey group of the “Health Behaviour in School-aged Children Study” were included in this study, a seperate approval from the international coordinatorship of the HBSC study was not necessary for use of the questions. The second part consisted of a questionnaire form which investigated the type of internet access of the students, the period of usage of internet, which activities in the internet they participated in and with what frequency they participated in these activities, which was established as a result of literature screening per23
Çavdar et al. Health behaviors in adolescents
formed by the investigators and face to face interviews with the young individuals and which took its final shape as a result of a pilot study. In this study, only the time of usage of internet was included in the evaluation among these questions.
last 30 days: having consumed an alcoholic drink in the last 30 days albeit rarely. Having got drunk: having got drunk at least for one time for a life time. Having got drunk in the last 30 days: having got drunk in the last 30 days for at least one time.
Application Pilot application: The pilot study for the questions which measured internet use was conducted with 30 adolescents aged between 15 and 18 years who presented to Cerrahpaşa School of Medicine, Department of Pediatrics, Adolescent Outpatient Clinic because of different causes. These adolescents were primarily asked to fill in the questionnaire form alone. Afterwards, the questions were discussed with each of them using a semi-structured interview technique. Changes in the espressions were made in order to clarify some questions after the pilot study.
Spare time activities: Sufficient physical activity: performing moderate or severe physical activity for at least 1 hour each day of the week. Watching TV for long periods of time: watching TV for at least 2 hours a day. Using the internet for long periods of time: using the internet for at least 2 hours a day.
General application: The questionnaire form was applied in a class period of 45-60 minutes in all classes. Two investigators and the class teacher were present during the application in the classsroom. Before the application, the students were informed about the content of the study and that the participation was voluntary by reading a standard instruction. None of the students refused to participate in the study. The process of application of the questionnaire forms was completed in December 2014-January 2015. Data input and confirmation Data input was performed in January-February 2015 according to the data input guideline. Confirmation of the day input was completed by 2 members of the study team who worked in Cerrahpaşa Medical Faculty, Department of Public Health in accordance with the study protocol by reentering one of each 5 questionnaire forms. Data confirmation was completed in April 2915. Definition of behaviors In this study, the answers were primarily transformed into dichotomous variables for all behaviors investigated for statistical evaluation. Consumption of tobacco behaviors: Experimenting smoking: having smoked more than one breath in a life time. Having smoked in the last 30 days: having smoked at least one time in the last 30 days. Regular smoking in the last 30 days: having smoked 20 or more cigarettes in the last 30 days. Experimenting nargileh: having smoked nargileh at least one time for a life time. Consumption of alcoholic drink: Experimenting alcohol: having consumed alcohol more than a small amount for a life time. Having consumed alcohol in the 24
Turk Pediatri Ars 2016; 51: 22-34
Eating behaviors: Having regular breakfast: having breakfast for 7 days a week. Having regular breakfast on weekdays: having breakfast on each weekday. Consuming adequate amounts of fruit: eating fruit each day at least for once. Consuming adequate amounts of vegetable: eating vegetables each day at least for once. Consuming candy or chocolate frequently: consuming candy or chocolate at least for once every day. Consuming soft drinks frequently: consuming cola or other soft drinks for at least once every day. Dieting: Being on a diet at that moment in order to lose weight. Behaviors related with violence: Having been bullied: having been bullied for at least once in the last 1-2 months at school. Having been bullied frequently: having been bullied for at least twice in the last 1-2 months at school. Having bullied others: having bullied other students for at least once in the last 1-2 months at school. Having bullied others frequently: having bullied other students for at least twice in the last 1-2 months at school. Involving in a physical fight: having involved in a physical fight for at least once in the last 12 months. Having been involved in a physical fight frequently: having involved in a physical fight for at least 3 times in the last 12 months. Statistical analysis The frequencies of the behaviors in the same grade by gender were compared using chi-square test. It was evaluated if the frequencies of behaviors of students with the same gender in different grades varied by testing correlation using Cramer’s V coefficient method. Results Two thousand two hundred ninety six students attending 22 high schools in the province of Izmir were included in the study. While the number of registered students was 2 735 in the grades included in the study, 439 students were absent on the day of application (the rate of absenteesim was 16.5%). Therefore, a total of 2 296 students could be reached. The questionnaire
Turk Pediatri Ars 2016; 51: 22-34
Çavdar et al. Health behaviors in adolescents
Table 1. Distribution of the study group by gender and grades 9th grade
Total
Female
10th grade Male
Female
11th grade
Male
Female
12th grade
Male
Female
Male
n n %a n %a n %a n %a n %a n %a n %a n %a
Number of students
1986
304
49.2
314
50.8
238
50.4
234 49.6 248 52.8 222
47.2
249 58.5 177 41.5
Percentages of distribution by gender in each grade
a
Table 2. Mean ages of the study group by gender and grades 9th grade
Total
Mean age
Female
10th grade
Male
Female
11th grade
Male
Female
12th grade
Male
Female
Male
n
Mean ±SD Mean ±SD Mean ±SD Mean ±SD Mean ±SD Mean ±SD Mean ±SD Mean ±SD
1984
14.8 ±0.55 14.9 ±0.62 15.8 ±0.59 15.9 ±0.67 16.7 ±0.53 16.9 ±0.64 17.8 ±0.55 17.8 ±0.64
a
Percentages of distribution by gender in each grade
a
Table 3.
Behaviors of consumption of tobacco and alcoholic beverages of the students by grades and gender
Total Behaviors
Female
9th grade
Male
Female
10th grade Male
Female
11th grade
Male
Female
12th grade
Male
Female
Male
n n % n % p n % n % p n % n % p n % n % p n % n %c pd a
b
b
d
c
c
d
c
c
d
c
c
d
c
Experimenting 1 959 325 31.6 338 36.3 0.031 71 23.7 72 23.3 0.897 73 30.7 79 34.8 0.343 81 33.2 93 42.3 0.044 100 40.7 94 53.4 0.010 smoking Smoking in the 1 967 237 23 280 29.9
Original Article
TÜRK PEDİATRİ ARŞİVİ
Health behaviors in high school students in İzmir, Turkey Sabanur Çavdar1, Esin Çetinkaya Sümer1, Kayı Eliaçık2, Aslıhan Arslan2, Begüm Koyun2, Nurhan Korkmaz2, Ali Kanık2, Ethem Erginöz2, Oya Ercan3, Müjgan Alikaşifoğlu3 Department of Public Health, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey Clinic of Pediatrics, İzmir Tepecik Training and Research Hospital, İstanbul, Turkey 3 Department of Pediatrics, Division of Adolescent Health, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey 1 2
Abstract Aim: The aim of this cross-sectional study was to determine the prevalence of the self reported health behaviors and differences in these behaviors by gender and grades in high school adolescents in İzmir, Turkey. Material and Methods: A stratified cluster sampling procedure was used for this cross-sectional study. The study sample included 2 296 students attending 22 high schools in Izmir. As a data collection instrument, some questions from the Health Behavior in School-aged Children Study 2009/2010 questionnnaire and questions which were developed by the researchers to understand behaviors of internet use in adolescents were used. Chi-square tests and Cramer’s V statistics were used for statistical analyses. Results: Among the high school students, 33.8% experimented smoking, 26.3% smoked cigarette during the 30 days before the survey, 14.9% smoked cigarette regularly during the 30 days before the survey, 54.1% experimented drinking alcohol, 38.4% drunk alcohol during the 30 days before the survey, 31.6% got drunk, 10.9% were adequately physically active, 59.9% watched TV for a long period of time, 72.8% used internet for a long period of time, 48.1% ate breakfast regularly, 36.2% ate adequate amount of fruit, 14.1% ate adequate amount of vegetable, 31.3% ate candies and chocolate very often, 18% drunk soft drink very often, 30.3% were bullied, 29.9% bullied others and 41% involved in a physical fight. Conclusions: These results showed that “Adolescent friendly health services” should be generalized all over Turkey, physicians should evaluate each adolescent for his/her health behaviors in each visit and implementation of prevention programs which adopt a health promotion perspective is necessary begining from the elementary school. (Turk Pediatri Ars 2016; 51: 22-34) Keywords: Alcohol, leisure time activities, adolescent, health behavior, violence, tobacco, eating behaviors
Introduction Adolescent is a Latin term which means “maturation by development” and expresses the period of transition from childhood to adulthood. This period which is also called puberty is a stressful and fluctuant period for the intividual and his/her connections during which many changes in terms of physical, cognitive, psychological and social aspects are experienced in association (1). Problems which may occur in one of the maturation processes may prevent healthy development in adolescents by affecting the other processes and cause to diseases which are also carried to adulthood (1, 2). The most important characteristic which is observed typically in adolescence is tendency to take risk. This tendency may cause to adoption of negative behaviors and attitudes related with health including use of tobacco, alcohol and substance which constitutes the ba-
22
sis for non-infectious diseases, unsafe sexual relation, consumption of nutrients with low nutritional value and high fat and calorie content and sedantary life-style or may render these behaviors and attitudes a life-style (2-5). These attitutes and behaviors may both affect the current health status of adolescents and cause to morbidity and mortality in adulthood (2, 3). For example, it is predicted that one fifth of adolescents aged 13-15 years smoke at the present time and approximately half of the individuals who smoke in adolescence will continue this behavior for at least 15 years more (2). The most important characteristic of the behaviors observed in adolescents which affect health adversely is that they are preventable to a large extent (5). Therefore, adolescence is considered an opportunity for preventing carriage of the behaviors which affect health adversely to adulthood (3). In addition, detailed information about health-related behaviors and diseases of adolescents is necessary in terms of accurate development of inter-
Address for Correspondence: Oya Ercan E-mail: [email protected] Received: 14.09.2015 Accepted: 13.11.2015 ©Copyright 2016 by Turkish Pediatric Association - Available online at www.turkpediatriarsivi.com DOI: 10.5152/TurkPediatriArs.2016.3389
Turk Pediatri Ars 2016; 51: 22-34
vention programs for both adolescence and childhood (3, 4). Another important point related with health-related behaviors in adolescents is that adolescents tend to exhibit multiple risky behaviors in association (6). The characteristic of the behaviors which may affect health adversely of clustering poses a risk of occurence of other behaviors in presence of one behavior, while it is an opportunity for interventions directed to one behavior to also prevent the others (6, 7). In our country in which the 15-19 age group constitutes 8.1% of the population, studies should be conducted in order obtain information about the health states of the young ones, their health-related behaviors and social and personal factors which lead to occurence of these behaviors, to evaluate the changes in these behaviors in time, to determine the priorities for programs which would be prepared to protect and develop the youngster’s health and to observe the effects of the interventions performed (8). In this cross-sectional study, it was aimed to determine the frequency of self-reported health-related behaviors of the young individuals who attended high school in Izmir, the distribution of these behaviors by gender and grade and the primary areas in adolescent health programs. Material and Methods This study constituted a part of a cross-sectional survey based on evaluation of a questionnaire form read and responded by students. This questionnaire form was designed to determine self-reported health states, health-related behaviors and the factors related with these behaviors in adolescents attending high school in Izmir. Two thousand two hundred ninety six students who attended 22 high schools in Izmir were included in the study. Ethics committee approval was obtained from the Tepecik Education and Research Hospital Ethics Committee (meeting dated 09.30.2014,decision number: 10) and the necessary approval was obtained from the Izmir provincial directorate for national education (article dated 12.10.2014 with number 6297744). Sample selection Stratified cluster sampling method was used for selection of the sample. The sampling unit was accepted to be “school”. The high schools were considered as two strata including general high schools and vocational high schools according to the type of education. The 2013/2014 academic year of İzmir Provincial Directorate for National Education data were used to frame the study population. Private high schools and
Çavdar et al. Health behaviors in adolescents
private area high schools were excluded from the study. The students in the high schools which were excluded constituted 69% of the population. Conclusively, the population was established as 193 370 students including 86 275 students studying at general high schools and 107 095 students studying at vocational high schools. The sample was calculated with 95% confidence interval, 80% power and 2% margin of error. Each stratum and each class was represented in the sample with its ratio inside the population and the sample size was determined to be 2 062 students with corrections including stratum, classroom and rounding. The design effect was calculated to be 1.28. It was thought that the high school students obtained from this sample would represent the young individuals attending high school in the province of İzmir. The classes for which the questionnaire form would be applied were determined by drawing lots at the level of district, school and class. It was taken care of that at least one general high school and one vocational high school were included in each district. The questionnaire form was applied to studets who were present on the day of application and who volunteered to participate in the study in the classes which were chosen by lot. The application was performed in a total of 101 classes in 22 schools. Data collection tools used in the study A questionnaire form composed of two parts was used as data collection tool in this study. The first part consisted of 37 questions. These questions were obtained from the international questionnaire form belonging to an international survey named “Health Behaviour in School-aged Children Study-2009/2010 (HBSC 2009/2010)” (9). The questions related with gender, class, age, eating habits, dieting, physical activity, use of tobacco and alcohol, state of well-being, body weight, height, health complaints, body image, bullying, socioeconomical status, school life and family structure were selected from this questionnaire form. Since the conducters of the Turkey group of the “Health Behaviour in School-aged Children Study” were included in this study, a seperate approval from the international coordinatorship of the HBSC study was not necessary for use of the questions. The second part consisted of a questionnaire form which investigated the type of internet access of the students, the period of usage of internet, which activities in the internet they participated in and with what frequency they participated in these activities, which was established as a result of literature screening per23
Çavdar et al. Health behaviors in adolescents
formed by the investigators and face to face interviews with the young individuals and which took its final shape as a result of a pilot study. In this study, only the time of usage of internet was included in the evaluation among these questions.
last 30 days: having consumed an alcoholic drink in the last 30 days albeit rarely. Having got drunk: having got drunk at least for one time for a life time. Having got drunk in the last 30 days: having got drunk in the last 30 days for at least one time.
Application Pilot application: The pilot study for the questions which measured internet use was conducted with 30 adolescents aged between 15 and 18 years who presented to Cerrahpaşa School of Medicine, Department of Pediatrics, Adolescent Outpatient Clinic because of different causes. These adolescents were primarily asked to fill in the questionnaire form alone. Afterwards, the questions were discussed with each of them using a semi-structured interview technique. Changes in the espressions were made in order to clarify some questions after the pilot study.
Spare time activities: Sufficient physical activity: performing moderate or severe physical activity for at least 1 hour each day of the week. Watching TV for long periods of time: watching TV for at least 2 hours a day. Using the internet for long periods of time: using the internet for at least 2 hours a day.
General application: The questionnaire form was applied in a class period of 45-60 minutes in all classes. Two investigators and the class teacher were present during the application in the classsroom. Before the application, the students were informed about the content of the study and that the participation was voluntary by reading a standard instruction. None of the students refused to participate in the study. The process of application of the questionnaire forms was completed in December 2014-January 2015. Data input and confirmation Data input was performed in January-February 2015 according to the data input guideline. Confirmation of the day input was completed by 2 members of the study team who worked in Cerrahpaşa Medical Faculty, Department of Public Health in accordance with the study protocol by reentering one of each 5 questionnaire forms. Data confirmation was completed in April 2915. Definition of behaviors In this study, the answers were primarily transformed into dichotomous variables for all behaviors investigated for statistical evaluation. Consumption of tobacco behaviors: Experimenting smoking: having smoked more than one breath in a life time. Having smoked in the last 30 days: having smoked at least one time in the last 30 days. Regular smoking in the last 30 days: having smoked 20 or more cigarettes in the last 30 days. Experimenting nargileh: having smoked nargileh at least one time for a life time. Consumption of alcoholic drink: Experimenting alcohol: having consumed alcohol more than a small amount for a life time. Having consumed alcohol in the 24
Turk Pediatri Ars 2016; 51: 22-34
Eating behaviors: Having regular breakfast: having breakfast for 7 days a week. Having regular breakfast on weekdays: having breakfast on each weekday. Consuming adequate amounts of fruit: eating fruit each day at least for once. Consuming adequate amounts of vegetable: eating vegetables each day at least for once. Consuming candy or chocolate frequently: consuming candy or chocolate at least for once every day. Consuming soft drinks frequently: consuming cola or other soft drinks for at least once every day. Dieting: Being on a diet at that moment in order to lose weight. Behaviors related with violence: Having been bullied: having been bullied for at least once in the last 1-2 months at school. Having been bullied frequently: having been bullied for at least twice in the last 1-2 months at school. Having bullied others: having bullied other students for at least once in the last 1-2 months at school. Having bullied others frequently: having bullied other students for at least twice in the last 1-2 months at school. Involving in a physical fight: having involved in a physical fight for at least once in the last 12 months. Having been involved in a physical fight frequently: having involved in a physical fight for at least 3 times in the last 12 months. Statistical analysis The frequencies of the behaviors in the same grade by gender were compared using chi-square test. It was evaluated if the frequencies of behaviors of students with the same gender in different grades varied by testing correlation using Cramer’s V coefficient method. Results Two thousand two hundred ninety six students attending 22 high schools in the province of Izmir were included in the study. While the number of registered students was 2 735 in the grades included in the study, 439 students were absent on the day of application (the rate of absenteesim was 16.5%). Therefore, a total of 2 296 students could be reached. The questionnaire
Turk Pediatri Ars 2016; 51: 22-34
Çavdar et al. Health behaviors in adolescents
Table 1. Distribution of the study group by gender and grades 9th grade
Total
Female
10th grade Male
Female
11th grade
Male
Female
12th grade
Male
Female
Male
n n %a n %a n %a n %a n %a n %a n %a n %a
Number of students
1986
304
49.2
314
50.8
238
50.4
234 49.6 248 52.8 222
47.2
249 58.5 177 41.5
Percentages of distribution by gender in each grade
a
Table 2. Mean ages of the study group by gender and grades 9th grade
Total
Mean age
Female
10th grade
Male
Female
11th grade
Male
Female
12th grade
Male
Female
Male
n
Mean ±SD Mean ±SD Mean ±SD Mean ±SD Mean ±SD Mean ±SD Mean ±SD Mean ±SD
1984
14.8 ±0.55 14.9 ±0.62 15.8 ±0.59 15.9 ±0.67 16.7 ±0.53 16.9 ±0.64 17.8 ±0.55 17.8 ±0.64
a
Percentages of distribution by gender in each grade
a
Table 3.
Behaviors of consumption of tobacco and alcoholic beverages of the students by grades and gender
Total Behaviors
Female
9th grade
Male
Female
10th grade Male
Female
11th grade
Male
Female
12th grade
Male
Female
Male
n n % n % p n % n % p n % n % p n % n % p n % n %c pd a
b
b
d
c
c
d
c
c
d
c
c
d
c
Experimenting 1 959 325 31.6 338 36.3 0.031 71 23.7 72 23.3 0.897 73 30.7 79 34.8 0.343 81 33.2 93 42.3 0.044 100 40.7 94 53.4 0.010 smoking Smoking in the 1 967 237 23 280 29.9
