| ObjectiveTo study the epidemiological characteristics of problem behavior and the tendency of neurotransmitter deficiency among junior high school students, to analyze the influential factors of problem behavior and to explore the relationship between behavioral problems and neurotransmitter deficiency, then to formulate an integrative intervention program against the problem behavior and to evaluate the effects of the short-term intervention.Methods1. Current status of problem behavior and tendency of neurotransmitter deficiencyWith stratified cluster sampling method, we recruited 1259 students of seventh grade from 4 middle schools (two key middle schools, one common middle school and one boarding school) in Wuhan city of mainland China for the investigation. With the approval of school and parents consent, they were invited to complete the Youth Self-Report (YSR) questionnaire, the Bad Behavior Scale, the Internet Addiction Test (IAT) Scale and Symptom Scale of Neurotransmitter Deficiency (SSND) questionnaire. Rejected the unqualified questionnaire, the surplus sample was 1218, and the valid usable return rate was 96.74%.2. Risk factor analysisUsing the first and second part of data related to problem behavior and neurotransmitter deficiency on adolescents, we analyzed the influencing factors of behavioral problems.3. Intervention effect evaluationTwo schools were selected by the bureaus, four invention groups and four controls. Experimental group included 195 students and they accepted the intervention model developed in this topic, while control group included 203 students and they received the health education classes formulated by the school. The intervention method consisted of intensive classes, organizing the lecture, group discussion and so on. After experiment group took the intervention of a period of seven classes, we invited the students of experimental group and control group to fill out the questionnaires and evaluate the short-term intervention effect. Because of missing 7 students, so the control group included 196 pupils.4. Statstical methodsAll survey data were input the EpiData3.0 database, then, the software package SPSS for windows (Version 12.0) was used in all analyses. We calculated Cronbach's a coefficient and split-half coefficient to evaluate the reliability of the YSR and SSND scale. Descriptive analysis was employed to analyze the adolescents'general characteristics; Hypothesis tests were analyzed with independent t-test or t'-test, chi-square test or Fisher's exact test at the 0.05 level, two-tailed. Apart from these, Pearson's bivariate correlation was applied to examine the internal consistency of the YSR and SSND questionnaires. Then, canonical correlation analysis was conducted to further see the relationship between the biochemical scales of SSND and the syndrome scales within YSR. Finally, the ordinal logistic regression analysis was used to find out the main factors influencing the internet addiction.Results1. Occurrence rate of problem behavior and neurotransmitter deficiencyOf the 1218 students,186 students had behavior problems, the positive rate was 15.27%, and male students were 15.47% and female ones 15.04%. Girls tended to have some internalizing problems while boys tended to present several delinquent behaviors. In addition, smoking rate and drinking rate were respectively 3.29% and 32.92%. Referring to students surfing the net, the internet addiction tendency(IAT) rate and the Internet Addiction disorder(IAD) rate were 10.87% and 7.71% respectively, the IAT and the IAD detection rate of male student was significantly higher than that of female students'. Among 14 items concerning the classroom problem behavior,710 students talked in class,366 students read the extracurricular books,329 students had attention deficits and 280 students eated in class.Girls had higher scores on deficiency of dopamine (DA), gamma aminobutyric acid (GABA), serotonin (5-HT) and total scores, but lower scores on the acetylcholine (ACH) scales than boys did, which showed the level of girls'neurotransmitter deficiency was more serious than boys'.2. Results of risk factor analysisThe results of multiple Logistic regression analysis indicated that parents'education, occupation and parental rearing style were risk factors of incidence rate to 7th grade students. In particular, the protection factors were listed:parents'occupation were teacher, parents'education were higher, both parents raised the children.Pearson's bivariate correlation analysis showed that the correlation coefficients between each subscale of YSR and SSND ranged from 0.24 to 0.61 with all P< 0.01. Canonical correlation analysis indicated that anxious/depressed was interrelated with insufficiency of GABA and 5-HT; famine of DA might influence the attention problems; aggressive behavior might be associated with inadequate GABA. We also found that the primary factor influcing rate of smoking and drinking was shortage of GABA.By the ordinal logistic regression analysis, the relative factors mainly involved 6 aspects in IAD, such as sex, the surfer number of times, the surfer time, the surfer place and the surfer expense. Separately, male student is chief risk factors; surfing the internet 1 to10 times a month, spending about 1 to3 hours on internet, surfing the internet in the school library were protective factors.3. Results of effects on the interventionBehavior problem occurrence rate of the experiment group students fell from 15.89% to 7.20% after being received 2 month-long synthetic intervention. While behavior problem occurrence rate of the control group students fell from 14.29% to 13.27% after being accepted the school health curriculum.The smoking and drinking rates of test group of students after intervenation were significantly lower than those before intervenation. However, the smoking and drinking rate of control group of students after intervenation were higher than those before intervenation.The number of IAT and IAD students of experimental group had declined after the intervention, meanwhile, students had learned how to use internet to search information and course study, how to control themselves to play less computer games and surf less adult sites. Nevertheless, the number of IAT and IAD students of control group had increased after the intervention and more students played games and chated with friends.After the intervention, the incidence rate of classroom problem behavior of experimental group had fallen slightly and the class and grade atmosphere became unitive and harmonious. But the incidence rate of classroom problem behavior of control group had increased.Conclusion1. The incidence of problem behavior was high in first-grade junior students in Wuhan, which situation is unoptimistic. The school, teacher and guardian should collaborate to develop a reasonable and feasible intervention program, and promptly carry on the effective intervention on the behavioural problems of students, then reduce the occurrence of problem behavior. Apart from these, teacher and parents should pay more attention to bodies and psychology development of high school student. Well then, they can safeguard against a series of problem behaviors.2. Parents'education, occupation and parental rearing style were risk factors of problem behavior to 7th grade students. Furthermore, the opinion that neurotransmitter deficiency might cause mental and emotional problems was been proofed.3. Through the short-term intervention, students have already realized the hurting of problem behavior and mastered the most basic knowledge of how to prevent problem behavior. After that, the incidence of problem behavior has greatly reduced.Innovation1. This was the first comprehensive survey ever in the field of problem behavior on 7th grade students in China. The survey covered unhealthy life behavior, phenomenon of internet addiction and incidence rate of classroom problem behavior. At the same time, main influencing factors of behavioral problems were discovered through using multiple logistic regression analysis.2. The Symptom Scale of Neurotransmitter Deficiency (SSND) questionnaire was applied to detect the level of neurotransmitter deficiency of the junior high school students for the first time. We proofed hypothesis that problem behavior was related with neurotransmitter deficiency and reached the equation between the two factors by using canonical correlation analysis.3. The incidence rate of problem behavior was greatly reduced by applying this integrative intervention program. It was feasible to implement this pattern in the next wide range.
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