# Factors associated with meeting the recommendations for physical activity, sedentary behavior, and sleep in adolescents: a cross-sectional study

## TL;DR

This study explores how social and environmental factors influence adolescents' adherence to physical activity, sedentary behavior, and sleep guidelines.

## Contribution

The study integrates the Social Ecological Model to analyze combined adherence to multiple health behavior recommendations in adolescents.

## Key findings

- Only 1.8% of adolescents met all three health behavior recommendations simultaneously.
- Enjoying physical activity and good self-rated sleep quality were strongly associated with meeting combined recommendations.
- Having more friends and participating in physical education classes were linked to better adherence to physical activity and sedentary behavior guidelines.

## Abstract

To analyze the association between the Social Ecological Model and meeting the physical activity, sedentary behavior, and sleep recommendations in a combined and integrated manner among adolescents.

This is a cross-sectional study conducted in public schools in the Metropolitan Region of Recife, state of Pernambuco, Brazil, with adolescents aged 14 to 17 years. An adapted version of the Global School-based Student Health Survey was used as the instrument. Robust Poisson regressions were performed.

Approximately 1.8% of the 576 adolescents met all three recommendations simultaneously. Enjoying physical activity (prevalence ratio [PR] 11.62; 95% confidence interval [CI] 1.50–89.75) was associated with the combined adherence to the physical activity and sedentary behavior recommendations. Having two or more friends (PR 0.38; 95%CI 0.18–0.76) and participating in one (PR 0.39; 95%CI 0.20–0.78) or two physical education classes per week (PR 0.43; 95%CI 0.20–0.92) were associated with lower probabilities of non-compliance with these recommendations. Self-rated sleep quality as good (PR 2.49; 95%CI 1.09–5.67) was associated with higher prevalence of meeting the combined recommendations for sedentary behavior and sleep. Being male (PR 0.48; 95%CI 0.23–0.97) and participating in one physical education class per week (PR 0.40; 95%CI 0.16– 0.99) were associated with lower prevalence of not meeting the recommendations for sedentary behavior and sleep. Self-reported sleep quality as good (PR 3.11; 95%CI 1.36–7.10) as well as being male (PR 2.10; 95%CI 1.14–3.87) were associated with a higher likelihood of meeting the combined recommendations for physical activity and sleep. Actively commuting to school (PR 0.48; 95%CI 0.27–0.83) was associated with a lower likelihood of not meeting these recommendations.

Intrapersonal, interpersonal, and community factors are associated with adherence to physical activity, sedentary behavior, and sleep recommendations in adolescents.