Improving adolescents’ health by identifying behavioral risk factors and protective factors

In order to reduce behavioral risk factors in the 21st century accurate and valid information is required on these factors and also about protective factors during these so called stormy years. . Attention to life-long behavioral risk factors and protective factors provides an alternative paradigm. Indeed, efforts to improve adolescent and pre-adolescent health typically features interventions designed to address specific health risk behaviors, such as physical inactivity, tobacco use, alcohol and drug use, violence, unintentional injuries and early sexual activities .As we know, the Global School-based Student Health Survey (GSHS) was developed by the World Health Organization and conducted among adolescents, aged 13–17 years, at a country level to obtain accurate information on behavioral risk factors and protective factors, with 335 items in 10 core questionnaire modules addressing the leading causes of morbidity and mortality among children and adults worldwide, including alcohol and tobacco use, dietary behaviors, drug use, hygiene, mental health, physical activity, violence and unintentional injuries, sexual behaviors that contribute to HIV infection and other sexually-transmitted infections, unintended pregnancy and protective factors .We found that internal consistency (Cronbach's alpha) in 2 modules of dietary behaviors (0.25) and physical activity (0.22) had the lowest reliability in comparison with other items.This finding suggests that although the tool that uses GSHS is accurate, it is necessary to pay more attention to issues in adolescent health-related contexts and it seems essential to pay more attention to and exercise caution in interpretation of data regarding items about dietary behavior and physical activity in using this questionnaire despite transcultural adaptation and validation of the GSHS questionnaire in Persian.This school-based self-report survey provided critical information for implementation across culturally diverse adolescents; therefore, culturally sensitive and locally valid questionnaires are essential to local health behavior risk factors and concerns in the global context. In addition, comparative cultural data on dietary behavior and physical activity are necessary to map the causal pathways and identify contributions of other risk factors such as peer pressure.