Impacts of Parental Relationship on Adolescents Non-Communicable Diseases (NCDs)-Related Healthy Lifestyle: from Family Systems and Life Course Perspectives

Background & Objective: To prevent Non-Communicable Diseases (NCDs), physical activity, healthy diet, tobacco use and alcohol use are the most common modifiable behaviors that frequently tending to establish during adolescence and persisting throughout life. According to family systems theory, both parental divorce and exposure to parental conflict are associated with low quality of parenting, which plays an important role in shaping child’s NCD-related lifestyle during adolescence. Few studies have examined the underlying NCD-related lifestyle development patterns measuring from multiple behavior indicators. Furthermore, previous studies have not explicitly examined the direct impact and interaction effect of parental marital status, parental conflict, and parenting on adolescent healthy lifestyle trajectory patterns from a lifecourse perspective. The aims of this study are to i) investigate long-term patterns in adolescent healthy lifestyle, and ii) explore the association of adolescent healthy lifestyle patterns with parental relationship (parental marriage status and parental conflict) and parenting (parental monitoring and parental control behavior) indicators from family systems and lifecourse perspectives. Methods: A longitudinal sample of 2,597 (4th grade in 2001, 51.52% male) students from the Child and Adolescent Behaviors in Long-term Evolution (CABLE) project was used. Longitudinal latent class analysis (LLCA), also referred to as repeated-measures latent class analysis (RMLCA) and multinomial logistic model were applied to identify NCD-related healthy lifestyle patterns and their predictors. Indicators measuring NCD-related healthy lifestyle patterns came from four variables (eating vegetable/fruit every day, physical activity 3 times a week, tobacco use and alcohol use), which repeatedly measured during 2001-2013. Parental relationship was assessed by parental marriage status and parental conflict from 2001 to 2009, whilst parenting (parental monitoring and parental control behavior) was measured during 2004-2006. Results: Decreased trends were observed in the prevalence of physical activity, healthy diet, non-tobacco use and non-alcohol use behaviors among students during the study period (from 4th grade to senior). The LCA model identified six latent classes (all posterior probability>0.73) by behavior indicators response probability during 2002-2011 (5th grade to sophomore): “healthy lifestyle (23.91%)”, “inactive lifestyle (18.57%)”, “insufficient vegetable/fruit intake, inactive and drinking lifestyle (13.35)”, “insufficient vegetable/fruit intake and inactivity lifestyle (20.30%)”, “early alcohol use lifestyle (11.90%)”, “high risk lifestyle (11.97%)”. During the high school period (2007-2009), five latent classes (all posterior probability>0.78) were identified: “inactive lifestyle (22.38%)”, “insufficient vegetable/fruit intake and inactivity lifestyle (22.51%)”, “healthy lifestyle (23.62%)”, “high risk lifestyle (12.43%)”, “insufficient vegetable/fruit intake, inactive and drinking lifestyle (19.06%)”. Using the healthy lifestyle class as the reference group, male, parental divorce, higher parental conflict level, lower parental monitoring, and higher parental control were associated with higher odds ratio of relatively unhealthy lifestyle patterns. The mediation effects of parental monitoring and parental control between parental relationship and adolescent healthy lifestyle patterns were confirmed using the sobel test. The more frequently the student was exposed to parental conflict, the greater was the risk of that individual having relatively unhealthy lifestyle. Impacts of parental divorce on adolescent healthy lifestyle were moderated by predivorce marital conflict. Parental divorce that happened later than elementary school period could protect adolescents who experienced high parental predivorce conflict from developing unhealthy lifestyle. For those adolescents who experienced parental divorce, parenting play a more important role on developing healthy lifestyle than adolescents who lived in married families. Conclusions: Findings showed the existence of heterogeneity of latent NCD-related lifestyle patterns during adolescence among Taiwanese students. Results revealed that both experience of parental divorce and repeated experiences of parental conflict over a student’s early life course are associated with increased risk of poor lifestyle during adolescence. There is a need for interventions and support policies that might enable single parent to have appropriate parenting behaviors and help adolescent who lives in divorced family to develop a healthy lifestyle.