CABLE Child and Adolescent Behaviors in Long-term Evolution CABLE Research Team PI ： Hsing-yi Chang （張新儀） Lee-Lan Yen ( 李 蘭 ) Szu-Hsien T. Lee ( 李思賢 ) Wen-Chi Wu ( 吳文琪 ) Chi-Chen Wu （吳其臻） Yi-Chen Chiang （江宜珍）

Outline Background & Purposes Study Design Work Completed in 2001~2005 Work Will Be Conducted in 2006

Background Childhood is an important developmental stage. Early and successful interventions can improve children’s health behaviors and health status and can reduce social cost. A lifestyle based study following the development of children and their health related behaviors has never previously been conducted in Taiwan.

Datasets of Child Health in Other Countries HBSC Health Behavior in School-Aged Children, by WHO, Europe NLSC National Longitudinal Survey of Children, by Canada ADD National Longitudinal Study of Adolescent Health by North Carolina, Chapel Hill YRBSS Youth Risk Behavior Surveillance System, by US, CDC

Specific Aims To observe the change of health behavior, health status, mental health and lifestyle of children and adolescents. To examine the determinants of change. To differentiate the typologies of developmental trajectories.

Study Design (1) Cross-sectional Longitudinal Individual Family/Group Community/Society Changeability

Study Design (2) Grade Elementary SchoolJunior HighSenior High Year Accomplished 2001A1B1 2002A2B2 2003A3B3 2004A4B4 2005A5B5 Continuing 2006A6B6 2007A7B7 2008A8B8 2009A9B9 2010A10B10 A1-A10: The 1st cohort , include metropolitan and rural area; B1-B10: The 2nd cohort of , include metropolitan and rural area.

Study Framework Cross-Sectional Survey Intrapersonal Factors Interpersonal Factors Organizational Factors Health Lifestyle Health Status

Study Framework Longitudinal Follow-up Independent Variable Child & Parental Factors Family Factors School Factors Other Factors Intermediate Variable Time 1 → Time 2 Intrapersonal Factors Interpersonal Factors Organizational Factors Dependent Variable Time 1 → Time 2 Health Lifestyle Health Status

Study Subjects of 2001~2004 Add new participants

Follow-up rate Participants in 2001 as denominator Cohort 1Cohort 2Cohort 1Cohort N=2255N= N=2773N=

Field Survey, Student name list Inform consent Subject name list School survey --Student --Parent Check name list Cohort 1& Rearrange name list Mail survey --Student --Parent Mail survey -Student Cohort Cohort Rearrange name list Cohort 1& Rearrange name list Website survey --Student Cohort

Study Instruments & Data Collection Intrapersonal Factors Interpersonal Factors Organizational Factors Health Lifestyle Health Status CABLE Questionnaires Students+Parents +Teachers School Health Records School & Community Profiles

CABEL Questionnaire Student Version For 1st – 3rd graders Animal & Plant Version For 4th graders and older students Student Version

Contents of Student Version

Previous Achievements (I) Development of Positive Health Behaviors Sun protecting behavior is the lowest from 2001 to 2004 and decline annually. For cohort 2, most behaviors have increased before 2003, but decreased at Development of Negative Health Behaviors Staying up late, eating before sleeping, and using vulgar language are increased annually. For cohort 2, destroying public property are increased. Some Health Behaviors aggregated together. （邱靜如， 2003 ；吳文琪， 2005 ）

Previous Achievements (II) Correlates of health behaviors Student’s and parent’s characteristics, family interaction, school’s characteristics, community’s characteristics. Correlates of suicide ideation living in Taipei, using substance frequently, higher degree of depression, older mother, being punished frequently, lower family support, and girl with higher social loneliness Correlates of internal mental health student’s sex, family relationship, family conflict, school attachment （怜燕、李蘭、吳文琪、江宜珍， 2002 ；陳如毓， 2002 ；邱靜如， 2003 ；林芳美 2003 ；江宜珍， 2003 ；陳俐婷， 2003 ； 吳其臻， 2003 ； 張弘潔， 2004 ； Szu-Hsien Lee, Lee-Lan Yen, and Li-Ting Chen, 2004 ；高啟賢， 2004 ；傅建泰 2004 ； 吳文琪， 2005 ）

Results Dissemination from 2001 to 2004 Annual reports Annual Report 2001 has been published Annual Report 2002 has been published Annual Report has been published 2002 CABLE conference Reference for parents Application of CABLE questionnaires

Presentations and Publications from 2001 to 2004 (I) Conference papers 2002 ISHPA (2) 2002 APA (1 paper) 2002 TPA (1 paper) APHA (8 papers) 2004 First Conference on Statistical Methodology (1 paper) 2004 TPHA Annual Meeting (3 papers) 2005 Biennial Meeting of SRCD (1 paper)

Paper Writing & Publishing from 2001 to 2004 (II) Journal Article Yen LL, Chen L, Lee SH, Hsiao C, Pan LY. IUHPE- Promotion and Education 2002; Suppl. 1: Lee SH, Yen LL, Cheng LT. J Med Sci 2004; 24(4): 江宜珍, 吳肖琪, 李蘭. 台灣衛誌 (printed) 3 papers submitted

Professional Training MasterDoctor

CABLE’s Website

Data collection in 2006 Sixth graders (1st cohort) Subjects: Students + Parents Field survey at 19 primary schools in 2 area School health records transcribing Ninth graders (2nd cohort) Subjects: Students Field survey at 27 junior high schools Mail survey and internet survey for those who didn’t attend major those junior high schools

Major focus of 2006 Childhood overweight/obesity Mental health Effect of physical punishment Aggressive and addictive behavior Emerging issues

Data analysis in 2006 Cross-sectional and Longitudinal Analysis Multiple linear and logistic regression Multilevel analysis Structure equation model Latent growth curve model

Data Released A data-releasing guideline was drawn-up at 2003 October. Data of 2001 & 2002 were released. 1 foreign scholar and 3 domestic researchers are analyzing the data. The dataset of 2003 will be released in 2006.

CABLE’s Website in 2006 Maintain CABLE website Access the effectiveness of CABLE website for retrieving participants who didn’t be interviewed in school.

Significance The findings of CABLE will generate a dataset for observing the development of child and adolescent in Taiwan. According to the evidence based information from CABLE, related agencies can develop supporting and learning programs to improve child health.