The association between self-rated health and social environments, health behaviors and health outcomes: a structural equation analysis

Background: The factors shaping the health of the current generation of adolescents are multi-dimensional and complex. The purpose of this study was to explore the determinants of self-rated health (SRH) of adolescents attending a faith-based school system in Australia. Methods: A total of 788 students attending 21 Seventh-day Adventist schools in Australia responded to a health and lifestyle survey that assessed SRH as well as potential determinants of SRH including the health outcomes mental health, vitality, body mass index (BMI), select health behaviors, social factors and personal demographics. Structural equation modeling was used to analyze the data and examine the direct and indirect effects of these factors on SRH. Results: The structural model developed was a good fit with the data. The health outcome mental health had the strongest association with SRH (beta = 0.17). Several upstream variables were also associated with higher SRH ratings. The health behavior sleep hours had the strongest association with SRH (beta(total) = 0.178) followed by fruit/vegetable consumption (beta(total) = 0.144), physical activity (beta(total) = 0.135) and a vegetarian diet (beta(total) = 0.103). Of the demographic and social variables measured, adverse childhood experiences (ACEs) had the strongest association with SRH (beta(total) = -0.125), negatively influencing SRH, and gender also associated with an increase in SRH (beta(total) = 0.092), with the influence of these factors being mediated through other variables in the model. Conclusions: This study presents a conceptual model that illustrates the complex network of factors concomitantly associated with SRH in adolescents. The outcomes of the study provide insights into the determinants of adolescent SRH which may inform priority areas for improving this construct.