Exploring the association between mental wellbeing, health-related quality of life, family affluence and food choice in adolescents

Are hedonic hunger and health-related quality of life associated with obesity in adolescents?

The purpose of the study is to find out the relationship between obesity, hedonic hunger and health-related quality of life (HRQoL). The questionnaire containing items on the sociodemographic characteristics, anthropometric measurements and nutritional habits of individuals (n = 902), the Children's Power of Food Scale and the KIDSCREEN-10 were used to determine the hedonic hunger and the HRQoL score. Hedonic hunger and HRQoL were evaluated according to the categories, frequency of consumption of sugary drinks and fast food. The females were found to have hedonic hunger more than the males (p < 0.05). Body mass index z-score categories of the adolescents showed that the obese eat more hedonically compared to the underweight and the normal-weight (p < 0.05), and this difference was not observed in the HRQoL scores (p > 0.05). There was a negative correlation between the hedonic hunger status and the HRQoL scores (R = -0.342, p = 0.000). The consumption of sugary drinks and fast food was associated with hedonic hunger and HRQoL scores in certain groups. Hedonic hunger is associated with obesity; hedonic hunger and quality of life are important factors associated with unhealthy food and drink intake.

Association between university student junk food consumption and mental health

Background: On a global scale, the mental health consequences of eating habits among the general population are becoming a concern. Particular attention should be directed to the youthful population. Aims: Determine the relationship between university students' consumption of junk food and their levels of stress, anxiety, and depression. Method: University students were asked to complete: a demographic questionnaire, questions on junk food consumption, and depression anxiety stress scores (DASS-21). Body mass index measurements were taken. Logistic regressions were utilized to construct odds ratios (ORs) with 95% confidence intervals to identify the association between university students' consumption of junk food and their levels of stress, anxiety, and depression. Results: There were (N = 509), 66% females and 34% males, mean age was (M = 18.1 ± .5) years participated in this study. Daily consumption of junk food was significantly linked to stress (odds ratio [OR], 4.5; 95% confidence interval [CI], 2.5-8.3), anxiety (OR, 11.1; 95% CI, 6.2-20.1), and depression (OR, 7.9; 95% CI, 4.5-13.9). Conclusions: This is the first thorough study conducted in Egypt to examine the relationship between stress, anxiety, and depression, and junk food consumption among undergraduates at a private Egyptian university. Many college students struggle emotionally, and those who are emotionally troubled are more likely to participate in eating unhealthy food. Our research will be used to inform regional policies on adolescent nutrition and to create preventative strategies.

Free Drawing to assess food consumption information in comparison with the Free Listing: An intracultural study in Brazil with adolescents and dairy products

This study aimed to evaluate the Free Drawing method to assess food consumption information compared to the Free Listing method. Furthermore, the citation frequencies of dairy products consumed by adolescents were compared in Brazilian regions. Adolescents (14-17 years old, n = 265, n = 53 for each region, North, South, Northeast, Midwest, and Southeast regions) listed or drew the dairy products they consumed using Free Listing or Free Drawing. The contingency tables were constructed, and the cognitive saliency indexes (CSI) were calculated. Multiple Factor Analysis (MFA) was performed, and the RV indices were determined. The adolescents listed/drew 55 dairy products, grouped into 10 categories. The Free Listing method resulted in greater citation frequencies of dairy products. The Free Drawing method resulted in richer and more detailed information, with specifications of the type of product consumed within the category, flavor, type of packaging, and brand. The dairy products with the highest citation frequencies/CSI by adolescents were milk, cheese, and fermented milk. The South and Southeast regions observed greater citation frequencies and diversity of dairy products (prevalence in 6 categories). The CSI did not depend on the method, but it was affected by the region (p < 0.05). The sensory methods showed high similarity considering the categories of dairy products (RV = 0.80) and regions (RV = 0.79). It is concluded that the Free Drawing method proved to be an alternative to Free Listing for evaluating adolescents' consumption information of dairy products in an intracultural study in Brazil.

Clustering of Dietary Patterns Associated with Health-Related Quality of Life in Spanish Children and Adolescents

PURPOSE

The aim of the current study was to examine the association between dietary patterns and health-related quality of life (HRQoL) among Spanish children and adolescents.

METHODS

A modified version of the parental version of 10 items of the Screening for and Promotion of Health-Related Quality of Life in Children and Adolescents-a European Public Health perspective (KIDSCREEN-10) was used to assess children's HRQoL in three areas: subjective physical, mental, and social status. To evaluate dietary habits, a food frequency questionnaire was employed. To identify different feeding patterns in the sample of children and adolescents examined, cluster analyses were carried out. In addition, a generalized linear model with a Gaussian distribution was applied to test the associations between the determined clusters and HRQoL.

RESULTS

The lowest HRQoL was identified in participants located in the unhealthiest cluster (Cluster 1) (mean [M] = 85.2; 95% confidence interval [CI] 83.7 to 86.7). In comparison with the unhealthiest cluster (Cluster 1), a greater estimated marginal mean of HRQoL was identified for participants in the moderately healthy cluster (Cluster 1) (p = 0.020) and in the healthiest cluster (Cluster 2) (p = 0.044).

CONCLUSIONS

Based on our findings, dietary habits based on the low consumption of bread, cereals, and dairy products (mainly), together with low intake of fruits and vegetables, are related to lower HRQoL in children and adolescents. These results underscore the importance of promoting balanced and nutrient-rich diets among young populations. Public health initiatives should focus on educating parents, caregivers, and children about the benefits of a varied diet that includes adequate portions of fruits, vegetables, whole grains, and dairy products.

Factors associated with consuming unhealthy food in school children: A population-based study from Hong Kong

Background and Aims

Unhealthy diets were found to be the main contributor to the overweight problem among adolescents. In this study, we aim to identify the factors causing unhealthy eating habits in adolescents.

Methods

School-aged children and adolescents participated in this cross-sectional observational study with additional school and parental consent. A self-administered survey was conducted by 30 primary schools and 25 secondary schools. Participants were asked about the frequency of consuming unhealthy food and the types of unhealthy food consumed. A descriptive analysis was performed to demonstrate the proportions of characteristics. The prevalence of the outcome among participants of various factors was also analyzed using separate binary regression models.

Results

A total of 4884 responses were collected. Among primary school students (grade 4, mean age: 10.06), people who (1) were actively gaining weight (aOR: 1.651, 95% CI 1.006-2.708, p = 0.047), (2) went to bed after 11 p.m. (aOR: 1.652, 95% CI 1.065-2.563, p = 0.025), (3) had more than 2 h of gaming (aOR: 2.833, 95% CI 1.913-4.195, p < 0.001), (4) suffered from self-report depressive symptoms (aOR: 1.753, 95% CI 1.233-2.493, p = 0.002) was more likely to consume unhealthy food. As for secondary school students (grade 3, mean age: 15.28), (1) males (aOR: 1.266, 95% CI 1.0004-1.601, p = 0.0496), (2) average-to-high socioeconomic status (Average: aOR: 1.471, 95% CI 1.115-1.941, p = 0.006; High: aOR: 2.253, 95% CI 1.585-3.202. p < 0.001), (3) having more than 2 h of gaming (aOR: 1.342, 95% CI 1.069-1.685, p = 0.011), (4) suffering from psychological distress (aOR: 1.395, 95% CI 1.051-1.852, p = 0.021) were associated with the increased odds of consuming unhealthy food.

Conclusion

Several lifestyle and health factors were significantly associated with unhealthy eating behaviors in school-aged children and adolescents in Hong Kong, sharing similarities with many other countries. In conjunction with implementing a policy that addresses factors for unhealthy eating habits, further research should investigate potential interventions targeting these factors to ultimately tackle the overweight and obesity concern for children and adolescents in Hong Kong.

The international Family Affluence Scale (FAS): Charting 25 years of indicator development, evidence produced, and policy impact on adolescent health inequalities

In the absence of suitable indicators of adolescent socioeconomic status, the Family Affluence Scale (FAS) was first developed in Scotland 25 years ago. Since then, it has been adapted for use in the Health Behaviour in School-Aged Children (HBSC) Study to research inequalities in adolescent health in Europe and North America. FAS has also been used as an indicator of adolescent socioeconomic status in research studies outside of HBSC, worldwide. There has been a need for FAS to evolve and change its component items over time in order to take into account social and technological changes influencing the families of adolescents. This paper uniquely charts the development of FAS describing the methodological work carried out to validate the measure internationally and over time. It also presents an overview of the body of evidence on adolescent health inequalities produced over years from the HBSC Study and other research studies. Interviews conducted with policy stakeholders reveal that the evidence from FAS-related HBSC work has influenced their strategic work to raise awareness of inequalities and make the case for action to address these. Finally, the future of FAS is discussed with respect to its continual evolution in the context of technological, environmental and social change.

Characterizing nutrient patterns of food items in adolescent diet using data from a novel citizen science project and the US National Health and Nutrition Examination Survey (NHANES)

Introduction

A healthy diet is essential for promoting good health during adolescence and mitigating disease risks in adulthood. This underscores the need for improved nutrition education and increased access to healthier food choices. However, the accuracy of dietary data poses a significant challenge in nutritional research.

Methods

We utilized and analyzed a novel dietary record dataset collected through a high school citizen science project to address this issue. We focused on nutrients rather than food groups to characterize adolescent dietary patterns. The same analyses were performed on the 2019-2021 National Health and Nutrition Examination Survey data for comparison.

Results

Based on the U.S. Food and Drug Administration's recommended daily value (DV) for nutrients, the majority of food items in our citizen science dataset are low (i.e., <5% DV) in lipids, fiber, potassium, calcium, iron, sugar, and cholesterol. Only a minority of items are high (i.e., >20% DV) in macro and micronutrients. The clustering analysis identified nine food clusters with distinct nutrient profiles that vary significantly in size. The analyses on the NHANES data yielded similar findings, but with higher proportions of foods high in energy, lipids, carbohydrates, sugar, iron, and sodium compared with those of the citizen science dataset.

Discussion

This study demonstrates the potential of citizen science projects in gathering valuable dietary data and understanding adolescent nutrient intake. Identifying critical nutrient gaps can guide targeted nutrition education and the provision of accessible healthier food options, leading to positive health outcomes during adolescence and beyond.

The mediating effect of food choice upon associations between adolescent health-related quality of life and physical activity, social media use and abstinence from alcohol

BACKGROUND

Understanding how health-related quality of life (HRQoL) is related to lifestyle factors during adolescence is crucial to effective health promotion. The aim of this analysis was to identify associations between HRQoL and lifestyle and to determine the degree to which they are mediated by food choices in adolescents.

METHODS

The Wellbeing in Schools (NI) survey (N = 1609; 13-14 years) assessed HRQoL using the Kidscreen52. Food choice was assessed by Food Frequency Questionnaire (FFQ) and physical activity was assessed using the Physical Activity Questionnaire for Adolescents (PAQ-A). Social media and alcohol abstinence were self-reported.

RESULTS

Path analysis indicated that fruit and vegetable intake was associated with higher HRQoL on dimensions of moods and emotions, parent relations and home life, financial resources, and social support and peers. Bread and diary intake was related to higher physical wellbeing. Protein was associated with higher psychological wellbeing, moods and emotions, self-perception, parent relations and home life, financial resources, and lower social support and peers. Junk food was related to lower moods and emotions. Males had higher psychological wellbeing, moods and emotions, parental relations and home life. Females had higher self-perception, autonomy, and social support and peers. Greater physical activity explained higher HRQoL on all dimensions. Less social media was associated with higher psychological wellbeing, moods and emotions, self-perception, parent relations and home life, and school environment. Alcohol abstinence was associated with higher physical wellbeing, psychological wellbeing, moods and emotions, self-perception, parent relations and home life, and school environment dimensions.

CONCLUSION

Intervention to promote HRQoL in adolescents should consider food choices whilst encouraging physical activity, discouraging social media and deterring alcohol, and targeting boys and girls separately.

Impact of Parental Food Choices on Nutritional and Metabolic Status of Children with Type 1 Diabetes

Parents play a key role in what their children eat. The Food Choice Questionnaire (FCQ) has been used elsewhere to assess the dietary motivations of parents of healthy children, but not for parents of children with chronic diseases such as type 1 diabetes (T1D). The aim of our research was to evaluate the associations between parental food choice motivations and the nutritional status and glycemic control of children with T1D. A cross-sectional observational study of children aged 5 to 16 years with T1D attending the Pediatric Endocrinology Unit of Puerta del Mar University Hospital in Cádiz (Spain) was performed. Demographic, anthropometric and clinical data, including glycated hemoglobin, were collected. The FCQ in Spanish was conducted to assess the eating behaviors of the main caregivers of children with T1D. Significance was established at the level of p-value < 0.05. In total, 85 children with T1D (female 56.5%, age 12.07 ± 2.93 years, HbA1c 7.29 ± 0.77%) were recruited. Of these children, 31.3% showed HbA1c levels of <7.0% and 44.9% had a TIR >70%. A significant positive correlation was found between Hb1Ac and "familiarity" (R: +0.233). Anthropometric measures (weight, BMI, skinfolds and body circumferences) showed significant positive correlations with "sensory appeal" and "price". Parents' eating behaviors influence the nutritional status of their children with T1D and their glycemic control of the disease.

Do objective and subjective traffic-related pollution, physical activity and nature exposure affect mental wellbeing? Evidence from Shenzhen, China

Urban environment (e.g. greenspaces, air pollution and traffic noise) and individuals' behaviours (e.g. physical activity) have all been associated with mental wellbeing. The large majority of studies on the influence of nature exposure on mental wellbeing assumed that multiple pathways act independently, ignoring the interactions among potential correlated pathways that engage simultaneously. The parallel mediation approach fails to explore the complex associations of combined exposure to air pollution, traffic noise and nature exposure with physical activity, which in turn affect mental wellbeing. Hence, the interest of understanding the sophisticated interactions among different pathways is warranted. We utilized structural equation modelling to simultaneously evaluate whether actual and perceived traffic-related pollution and physical activity mediate the associations between mental wellbeing and nature exposure, which was assessed by Normalized Difference Vegetation Index (NDVI), green view index (GVI), green space density and park accessibility. In summer 2022, we conducted questionnaires from 1772 adults residing in 117 neighbourhoods in Shenzhen, China. Nature exposure was positively and directly associated with mental wellbeing in the single mediator model that considered physical activity only. The indirect effects of nature exposure on mental wellbeing were observed through all pathways in all models, except through the perceived acoustic quality pathway in the serial mediation model. In addition, the percentage mediated by perceived air quality was higher than that of perceived acoustic quality. The influence of nature exposure on mental wellbeing was only for a small proportion mediated by the physical activity pathway. The associations between nature exposure and mental wellbeing were modified by individual characteristics, such as gender, age, income level and alcohol usage, but not employment status and smoking behaviour. These findings point out the importance of both objective and subjective environmental features and human behaviours on mental wellbeing, as well as the necessity of considering multiple pathways simultaneously.

Effect of Sleep Changes on Health-Related Quality of Life in Healthy Children: A Secondary Analysis of the DREAM Crossover Trial

IMPORTANCE

Little is known regarding the effect of poor sleep on health-related quality of life (HRQOL) in healthy children.

OBJECTIVE

To determine the effect of induced mild sleep deprivation on HRQOL in children without major sleep issues.

DESIGN, SETTING, AND PARTICIPANTS

This prespecified secondary analysis focused on HRQOL, a secondary outcome of the Daily Rest, Eating, and Activity Monitoring (DREAM) randomized crossover trial of children who underwent alternating weeks of sleep restriction and sleep extension and a 1-week washout in between. The DREAM trial intervention was administered at participants' homes between October 2018 and March 2020. Participants were 100 children aged 8 to 12 years who lived in Dunedin, New Zealand; had no underlying medical conditions; and had parent- or guardian-reported normal sleep (8-11 hours/night). Data were analyzed between July 4 and September 1, 2022.

INTERVENTIONS

Bedtimes were manipulated to be 1 hour later (sleep restriction) and 1 hour earlier (sleep extension) than usual for 1 week each. Wake times were unchanged.

MAIN OUTCOMES AND MEASURES

All outcome measures were assessed during both intervention weeks. Sleep timing and duration were assessed using 7-night actigraphy. Children and parents rated the child's sleep disturbances (night) and impairment (day) using the 8-item Pediatric Sleep Disturbance and 8-item Sleep-Related Impairment scales of the Patient-Reported Outcomes Measurement Information System questionnaire. Child-reported HRQOL was assessed using the 27-item KIDSCREEN questionnaire with 5 subscale scores and a total score. Both questionnaires assessed the past 7 days at the end of each intervention week. Data were presented as mean differences and 95% CIs between the sleep restriction and extension weeks and were analyzed using intention to treat and an a priori difference in sleep of at least 30 minutes per night.

RESULTS

The final sample comprised 100 children (52 girls [52%]; mean [SD] age, 10.3 [1.4] years). During the sleep restriction week, children went to sleep 64 (95% CI, 58-70) minutes later, and sleep offset (wake time) was 18 (95% CI, 13-24) minutes later, meaning that children received 39 (95% CI, 32-46) minutes less of total sleep per night compared with the sleep extension week in which the total sleep time was 71 (95% CI, 64-78) minutes less in the per-protocol sample analysis. Both parents and children reported significantly less sleep disturbance at night but greater sleep impairment during the day with sleep restriction. Significant standardized reductions in physical well-being (standardized mean difference [SMD], -0.28; 95% CI, -0.49 to -0.08), coping in a school environment (SMD, -0.26; 95% CI, -0.42 to -0.09), and total HRQOL score (SMD, -0.21; 95% CI, -0.34 to -0.08) were reported by children during sleep restriction, with an additional reduction in social and peer support (SMD, -0.24; 95% CI, -0.47 to -0.01) in the per-protocol sample analysis.

CONCLUSIONS AND RELEVANCE

Results of this secondary analysis of the DREAM trial indicated that even 39 minutes less of sleep per night for 1 week significantly reduced several facets of HRQOL in children. This finding shows that ensuring children receive sufficient good-quality sleep is an important child health issue.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12618001671257.

Healthy and Unhealthy Food Consumption in Relation to Quality of Life among Finnish Female Municipal Employees: A Cross-Sectional Study

Aspects of good quality of life (QoL) have been found to motivate people to make lifestyle changes. There is also evidence that certain dietary patterns are associated with QoL. The aim of this work was to examine whether consumption frequencies of healthy and unhealthy food items are associated with QoL in female employees. A cross-sectional study was conducted among 631 Finnish female employees (mean age 49 years, SD = 10) from 10 municipal work units in 2015. Information about the participants was collected by physical examination, laboratory tests, self-administered questionnaires, including the Food Frequency Questionnaire (FFQ), and from medical history. QoL was assessed with the EUROHIS-Quality of Life 8-item index. A significant positive association was seen between consumption frequency of healthy foods and the EUROHIS-QOL mean score (p = 0.002). The association was small but comprehensive, also involving most dimensions of QoL. The consumption frequency of unhealthy foods was not associated with QoL. These findings are relevant when designing diet counselling, since QoL is an outcome that has been found to motivate people to change their health habits. Recommending abundant use of healthy foods could be a simple and convenient way of diet counselling at many health care appointments, where time consuming approaches are difficult to conduct.

Who Is Able to Resist What Is Forbidden?—The Relationship between Health Literacy and Risk Behaviours in Secondary School Students in the Broader Social and Educational Context

In the last Health Behaviour in School-Aged Children (HBSC) survey conducted in Poland in 2018, a group of 17-year-old adolescents (n = 1663; mean age 17.63 ± 0.36 years) was included outside the international protocol. This allowed an assessment to be made of their level of health literacy (HL) using the 10-point HBSC research tool. The aim of the study was to investigate the relationship between HL and risk behaviours (RB). A standardised index of RB in the last 30 days was considered as an outcome measure. This index was significantly higher in the group with low HL (0.318 ± 1.269) in comparison with the group with high HL (−0.083 ± 0.962). In a multivariate linear regression model, the strongest predictors of RB were gender, academic performance and level of regional deprivation, but the association with HL remained significant. This significant association persisted in general schools and in girls but disappeared in vocational schools and in boys. It was also shown that in rural areas, good academic performance has a less significant impact on RB if the HL level is low. The analyses led to the conclusion that when examining the relationship between HL and RB in older adolescents, it is advisable to take into account gender, the educational track and neighbourhood characteristics.

Investigation of the Associations between Diet Quality and Health-Related Quality of Life in a Sample of Swedish Adolescents

Most adolescents do not consume a high-quality diet, while self-reported mental health problems within this group are increasing. This study aimed to investigate the association between diet quality and health-related quality of life, and to explore the differences in diet quality and health-related quality of life between gender and parental education status. In this cross-sectional study, a detailed web-based recall method was implemented to determine dietary intake, which was analysed using the newly developed Swedish Healthy Eating Index for Adolescents 2015 (SHEIA15) and the Riksmaten Adolescents Diet Diversity Score (RADDS), to determine diet quality. The KIDSCREEN-10 questionnaire was used to measure health-related quality of life, and parental education was self-reported through questionnaires. Parental education was divided into two groups: ≤12 years or >12 years. The study included 1139 adolescents from grade 7 (13−14 years old), 51% were girls. The results showed that girls had higher scores for healthy eating and diet diversity but lower scores for health-related quality of life. A positive association was found between diet diversity and health-related quality of life (Adj R2 = 0.072, p = 0.001), between vegetable/fruit consumption and health-related quality of life (Adj R2 = 0.071, p = 0.002), and between healthy eating and diet diversity (Adj R2 = 0.214, p < 0.001). No association was found between healthy eating and health-related quality of life for all participants. The mean scores for healthy eating and diet diversity were significantly higher in the higher education parental group. In conclusion, higher diet diversity and increased fruit and vegetable consumption could be a strategy to improve health-related quality of life among adolescents. There is a need to promote better diet quality, especially in households of low parental education. In addition, there is a further need to investigate the potential benefits of improved diet quality on mental health and overall well-being.

Dietary patterns and health-related quality of life among Iranian adolescents

PURPOSE

Examining the associations of a-posteriori-defined dietary patterns and health-related quality of life (HRQOL) among Iranian adolescents.

METHODS

This cross-sectional study was conducted among 900 apparently healthy students (mean age 15.33 years; 53.0% female) during 2020-21. The validated Persian version of self-report Pediatric Quality of Life Inventory™ Version 4.0 Generic Core Scales (PedsQL) for healthy adolescents was used in an online survey to assess HRQOL. Total, physical health, psychosocial health, emotional functioning, social functioning, and school functioning PedsQL scores were calculated, and impaired HRQOL was defined as > 1 standard deviation below the total population sample mean PedsQL scores. A validated food frequency questionnaire was used to assess dietary intakes during telephone interviews. Daily intakes of 20 predefined food groups were calculated and submitted to the principal component factor analysis to identify a-posteriori-defined dietary patterns.

RESULTS

Three major dietary patterns labeled as Mediterranean, mixed, and unhealthy were identified, of which only the Mediterranean pattern characterized by high intakes of vegetables, fruits, olives, potatoes, eggs, nuts and legumes, pickles, low-fat dairy, fish, poultry, and vegetable oils was consistently associated with HRQOL. Controlling for covariates in the multivariable-adjusted binary logistic regression analysis, participants in the top tertile of Mediterranean pattern score were less likely to have impaired HRQOL than those in the bottom tertile (total: OR 0.25; physical health: OR 0.35; psychosocial health: OR 0.15; emotional functioning: OR 0.17; social functioning: OR 0.15; and school functioning: OR 0.18; all P < 0.010).

CONCLUSION

Current findings indicate that an a-posteriori-defined Mediterranean-style dietary pattern is associated with better HRQOL among healthy Iranian adolescents.

A multi-method exploration into the social networks of young teenagers and their physical activity behavior

Background

There is a need for novel interventions to target inadequate levels of adolescent physical activity behavior. Previous research indicates that better understanding of the processes by which social networks influence physical activity behavior in adolescents may be useful to enhance intervention design.

Methods

This study used a multi-methods approach to aid our understanding about the role of social networks for adolescent physical activity behavior. The quantitative phase of data collection was analyzed using a three-step linear regression model using cross-sectional data from the WiSe study (n = 529 participants, 48.6% female, mean age 14.38 years (SD 0.32)). A demographically reflective sub-sample of schools were invited to take part in the qualitative phase, which involved focus group discussions. Thematic analysis was used to explore findings from the quantitative phase in greater depth, and identify other themes pertaining to the association between social networks and physical activity behavior.

Results

Males’ physical activity behavior was predicted by their friend group (0.46, p = 0.007) whereas females’ physical activity was predicted by their best friend (0.21, p = 0.03). The three main findings that were uncovered by the regression analysis were explored during the qualitative phase: 1) friends have similar physical activity behaviors; 2) friendship social networks may influence differently early adolescent male and female physical activity behavior; 3) popularity and sociability were not associated with physical activity behavior. Two additional themes emerged from the analysis of focus group data: 4) social norms and 5) external factors that may impact the relationship between adolescent physical activity behavior and social networks.

Conclusions

The investigation of the interplay between the findings from each phase of the inquiry indicated that social networks influence in different ways and to different degrees the physical activity of adolescent males and females. In turn, these insights point to the need for a systematic tailoring process for the development and implementation of physical activity behavior interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-10081-0.