Are lifestyle behaviors associated with excellent self-rated health among American adolescents? A cross-sectional study.

Excellent self-rated health has been associated with decreased mortality and positive health outcomes in adults. However, less is known about youth populations. The FLASHE study, conducted by the National Cancer Institute, is a cross-sectional survey with publicly available self-reported data. The present study evaluated lifestyle behaviors and their relationship with excellent self-rated health in an adolescent population in the United States utilizing complete FLASHE data from 1250 adolescents (males N=626, mean age=14.5y, SD = 1.61y; and females N=624, mean age=14.4y, SD=1.57y). Logistic regression models were used to analyze associations between lifestyle behavior exposures and the outcome of excellent self-rated health. Lifestyle exposures included: free-time physical activity; sedentary behavior time; beneficial and detrimental food intake; perception of the importance of family meals; meeting sleep duration guidelines, having trouble sleeping, and having a regular bedtime. In addition, potential confounders included weight status, smoking, sex, age, socioeconomic status, and race/ethnicity in adjusted models. Approximately 47% of males (n=295) and 35% of females (n=217) reported having excellent self-rated health. In the fully adjusted model, the frequency of beneficial food intake (OR=1.06, 95%CI=1.02-1.11 for each additional exposure, p=0.004); perception of the importance of family meals (OR=1.88, 95%CI=1.35-2.63, strongly agree vs. not agree, p<0.001); frequency of physical activity in free-time (OR=2.17, 95%CI=1.20-3.92, very often vs. none, p<0.001; ); and had no trouble sleeping (OR=0.42, 95%CI=0.27-0.64, yes vs. no, p<0.001), were significantly associated with excellent self-rated health. These results support the importance of enhancing future efforts to implement salutogenic interventions that address health behaviors to improve health outcomes in adolescents, focusing on everyday living situations and actively promoting health.