Document Type : Original Article

Authors

1 Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin, University of Medical Sciences, Qazvin, Iran

2 Department of Educational Psychology, Kharazmi University

3 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences

4 Department of Epidemiology and Biostatistics, Knowledge Utilization Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

Abstract

BACKGROUND: Health promotion of adolescents requires appropriate evidences of its determinants.
The aim of this study was to investigate predictors of self-rated health (SRH) among adolescents
in Qazvin, Iran.
MATERIALS AND METHODS: In this descriptive cross-sectional study, with a multistage sampling
method, we recruited 1740 adolescents aged 12–19 years from 53 schools in Qazvin, Iran (2018). We
used the Strengths and Difficulties Questionnaire and Adolescents’ Academic Stress Questionnaire
for data collection. The analysis was conducted using a multilevel logistic regression model. Gender,
educational period, and socioeconomic status were considered as confounders.
RESULTS: Almost 21% of the adolescents reported their SRH suboptimal. Suboptimal SRH was
higher in girls and older adolescents. Mental health disorders and academic stress had a positive
association with SRH. However, this association was negative for academic achievement and
physical activity. The interaction between mental health disorders and academic stress with SRH
had a significant association in a crud regression model.
CONCLUSION: Mental health, academic stress, academic achievement, and physical activity were
important predictors for SRH. Interventions that focus on promoting mental health, academic stress,
academic achievement, and physical activity such as physical activity for 1 h and each day for 3 days
per week can improve SRH in adolescents. Hence, policymakers should pay more attention to this
issue in health promotion programs of adolescents.

Keywords

1. Investing in a Safe, Healthy and Productive Transition from
Childhood to Adulthood is Critical [cited 2019 July 20]. Available
from: https://datauniceforg/topic/adolescents/overview/.
2. Jodkowska M, Oblacińska A, Dzielska A, Nałęcz H, Fijałkowska
A. Behavioural factors as predictors of self-rated health among
polish adolescent girls. Dev Period Med 2019;23:109-16.
3. Adolescent Mental Health. Ensuring Mental Health and Wellbeing in an Adolescent’s Formative Years Can Foster a Better
Transition from Childhood to Adulthood [cited 2019 July 20].
Available from: https://datauniceforg/topic/child-health/
mental-health/.
4. Adolescent Mental Health [cited 2019 July 20]. Available
from: https://www.who.int/news-room/fact-sheets/de
tail/adolescent-mental-health.
5. Kapungu C, Petroni S, Allen NB, Brumana L, Collins PY, De Silva M,
et al. Gendered influences on adolescent mental health in lowincome and middle-income countries: Recommendations from an
expert convening. Lancet Child Adolesc Health 2018;2:85-6.
6. Dowd JB, Zajacova A. Does the predictive power of self-rated
health for subsequent mortality risk vary by socioeconomic status
in the US? Int J Epidemiol 2007;36:1214-21.
7. Waldhauer J, Kuntz B, Mauz E, Lampert T. Intergenerational
educational pathways and self-rated health in adolescence and
young adulthood: Results of the German KiGGS cohort. Int J
Environ Res Public Health 2019;16:684
8. Nedjat S. Is self-rated health a good indicator for assessment
of population health? A review article. Iranian J Epidemiol
2015;10:89-96.
9. Chandola T, Jenkinson C. Validating self-rated health in different
ethnic groups. Ethn Health 2000;5:151-9.
10. Burström B, Fredlund P. Self rated health: Is it as good a predictor
of subsequent mortality among adults in lower as well as in higher
social classes? J Epidemiol Community Health 2001;55:836-40.
11. Marques A, Peralta M, Santos T, Martins J, Gaspar de Matos M.
Self-rated health and health-related quality of life are related with
adolescents’ healthy lifestyle. Public Health 2019;170:89-94.
12. Yeo SC, Jos AM, Erwin C, Lee SM, Lee XK, Lo JC, et al. Associations
of sleep duration on school nights with self-rated health,
overweight, and depression symptoms in adolescents: Problems
and possible solutions. Sleep Med 2019;60:96-108.
13. Joffer J, Flacking R, Bergström E, Randell E, Jerdén L. Self-rated
health, subjective social status in school and socioeconomic
status in adolescents: A cross-sectional study. BMC Public Health
2019;19:785.
14. Ghalichi L, Nedjat S, Majdzadeh R, Hoseini M, Pournik O,
Mohammad K. Determinants of self-rated health in Tehran, from
individual characteristics towards community-level attributes.
Arch Iran Med 2015;18:266-71.
15. Shakya HB, Domingue B, Nagata JM, Cislaghi B, Weber A,
Darmstadt GL. Adolescent gender norms and adult health
outcomes in the USA: A prospective cohort study. Lancet Child
Adolesc Health 2019;3:529-38.
16. Malta DC, Oliveira MM, Machado IE, Prado RR, Stopa SR,
Crespo CD, et al. Characteristics associated to a poor self-rated
health in Brazilian adolescents, National Adolescent School-based
Health Survey, 2015. Rev Bras Epidemiol 2018;21:e180018.
17. Aho H, Koivisto AM, Paavilainen E, Joronen K. The relationship
between peer relations, self-rated health and smoking behaviour
in secondary vocational schools. Nurs Open 2019;6:754-64.
18. Joffer J, Jerdén L, Öhman A, Flacking R. Exploring self-rated health
among adolescents: A think-aloud study. BMC Public Health
2016;16:156.
19. Abdollahpour I, Nedjat S, Noroozian M, Salimi Y, Majdzadeh R.
Positive Aspects of Caregiving Questionnaire. J Geriatr Psychiatry
Neurol 2017;30:77-83.
20. Kjeldsen MZ, Stapelfeldt CM, Lindholdt L, Lund T, Labriola M.
Reading and writing difficulties and self-rated health among
Danish adolescents: Cross-sectional study from the FOCA cohort.
BMC Public Health 2019;19:537.
21. Abdollahpour I, Nedjat S, Noroozian M, Salimi Y, Majdzadeh R.
Caregiver burden: The strongest predictor of self-rated health in
caregivers of patients with dementia. J Geriatr Psychiatry Neurol
2014;27:172-80.
22. Baigi V, Nedjat S, Hosseinpoor AR, Sartipi M, Salimi Y,
Fotouhi A. Socioeconomic inequality in health domains in
Tehran: A population-based cross-sectional study. BMJ Open
2018;8:018298.
23. Elgar FJ, Pförtner TK, Moor I, De Clercq B, Stevens GW, Currie C.
Socioeconomic inequalities in adolescent health 2002-2010: A timeseries analysis of 34 countries participating in the health behaviour
in school-aged children study. Lancet 2015;385:2088-95.
24. Moor I, Kuipers MA, Lorant V, Pförtner TK, Kinnunen JM,
Rathmann K, et al. Inequalities in adolescent self-rated health
and smoking in Europe: Comparing different indicators
of socioeconomic status. J Epidemiol Community Health
2019;73:963-70.
25. Ghanizadeh A, Izadpanah A. Scale validation of the strengths and
difficulties questionnaire in Iranian children. Iran J Psychiatry
2007;2:651-71.
26. Hosseinkhani Z, Nedjat S, Hassanabadi HR, Parsaeian M,
Veysi Hampa F. Designing and psychometric evaluation of
Iranian students’ academic stress questionnaire (IAASQ). Iran J
Public Health 2020;49:701-10.
27. Zhang F, Zhao L, Feng X, Hu X. An investigation on self-rated
health of adolescent students and influencing factors from
Sichuan, China. Am J Ther 2016;23:e1143-50.
28. Srugo SA, de Groh M, Jiang Y, Morrison HI, Hamilton HA,
Villeneuve PJ. Assessing the impact of school-based greenness
on mental health among adolescent students in Ontario, Canada.
Int J Environ Res Public Health 2019;16:4364.
29. Powell-Young YM. Household income and spiritual well-being
but not body mass index as determinants of poor self-rated
health among African American adolescents. Res Nurs Health
2012;35:219-30.
30. Krause L, Lampert T. Relation between overweight/obesity
and self-rated health among adolescents in Germany. Do socioeconomic status and type of school have an impact on that
relation? Int J Environ Res Public Health 2015;12:2262-76.
31. Breidablik HJ, Meland E, Holmen TL, Lydersen S. Role of parents
in adolescent self-rated health: Norwegian nord-trøndelag health
study. Adolesc Health Med Ther 2010;1:97-104.
32. Bertoldi AD, Camargo AL, Silveira MP, Menezes AM,
Assunção MC, Gonçalves H, et al. Self-medication among
adolescents aged 18 years: The 1993 Pelotas (Brazil) birth cohort
study. J Adolesc Health 2014;55:175-81.
33. Sharma B, Nam EW, Kim D, Yoon YM, Kim Y, Kim HY. Role of
gender, family, lifestyle and psychological factors in self-rated
health among urban adolescents in Peru: A school-based crosssectional survey. BMJ Open 2016;6:010149.
34. Spein AR, Pedersen CP, Silviken AC, Melhus M, Kvernmo SE,
Bjerregaard P. Self-rated health among Greenlandic Inuit and Norwegian Sami adolescents: Associated risk and protective
correlates. Int J Circumpolar Health 2013;72:19793
35. Ssewamala FM, Han CK, Neilands TB. Asset ownership and
health and mental health functioning among AIDS-orphaned
adolescents: Findings from a randomized clinical trial in rural
Uganda. Soc Sci Med 2009;69:191-8.
36. Nedjat S, Hosseinpoor AR, Forouzanfar MH, Golestan B,
Majdzadeh R. Decomposing socioeconomic inequality in
self-rated health in Tehran. J Epidemiol Community Health
2012;66:495-500.
37. Meireles AL, Xavier CC, de Souza Andrade AC, Proietti FA,
Caiaffa WT. Self-rated health among urban adolescents: The
roles of age, gender, and their associated factors. PLoS One
2015;10:1-19
38. Hosseinkhani Z, Nedjat S, Hassanabadi HR, Parsaeian M.
Academic stress from the viewpoint of Iranian adolescents:
A qualitative study. J Educ Health Promot 2019;8:13.
39. Conklin AI, Yao CA, Richardson CG. Chronic sleep disturbance,
not chronic sleep deprivation, is associated with self-rated health
in adolescents. Prev Med 2019;124:11-6.
40. Jackson DB, Vaughn MG. Adolescent health lifestyles and
educational risk: Findings from the monitoring the future study,
2010-2016. Am J Prev Med 2019;57:470-7.
41. Pranjić N, Brković A, Beganlić A. Discontent with financial
situation, self-rated health, and well-being of adolescents in
Bosnia and Herzegovina: Cross-sectional study in Tuzla Canton.
Croat Med J 2007;48:691-700.
42. Boardman JD. Self-rated health among U.S. adolescents. J Adolesc
Health 2006;38:401-8.
43. Sonu S, Post S, Feinglass J. Adverse childhood experiences and
the onset of chronic disease in young adulthood. Prev Med
2019;123:163-70.
44. Hosseini M, Maghami M, Kelishadi R, Motlagh ME, Khoshbin S,
Amirkhani A, et al. First report on self-rated health in a nationallyrepresentative sample of Iranian adolescents: The CASPIAN-iii
study. Int J Prev Med 2013;4:146-52.