| BackgroundAdolescents are the future of the country and the hope of the nation.Adolescence is a key stage in the development of life.The rapid changes in biology and psychology that occurred in the "second decade,affected all aspects of adolescent life,and these changes make adolescents a unique period in their life cycle,and also an important period to lay a foundation for adult health.With the growing importance of adolescent health,the international community and Chinese government have paid great attention to it.The Global Strategy for Women,s,Children's and Adolescents' Health(2016-2030)released by the United Nations,WHO,UNICEF,etc.,included adolescents aged 10-19 as one of the core groups of global health action strategies for the first time,and proposed a series of measures and monitoring indicators to promote adolescent health.In China,the 2016 National Health and Wellness Conference puts special emphasis on“emphasizing the health of children and adolescents";the Plan of Health China 2030 also puts forward specific requirements for the health of children and adolescents.Adolescence is usually considered a healthy period with a low disease burden.However,the current health status of adolescents is not optimistic and still faces enormous challenges.Health risk factors associated with most chronic noncommunicable diseases begin in adolescence or are consolidated during this period;adolescents' psychological problems are increasingly prominent;overweight and obesity,low vision,health-related risk behaviors,and other health problems are It is in a trend of generalization and aging.These behaviors and factors seriously affect the health and development of adolescents,and the future will also affect the health of adulthood.Therefore,monitoring and evaluating adolescent health,mastering the health status and trends of adolescents,and discovering existing health problems are of great significance for improving the health of adolescents.ObjectivesTaking the adolescents aged 10-18 in the physical examination database of primary and secondary school students from 2014 to 2018 in Shandong Province as the research object.On the basis of descriptive analysis of indicators such as body shape,physiological function and physical illness,the comprehensive evaluation index system of adolescent health was constructed by attribute hierarchy method(AHM),and BP neural network optimized by genetic algorithm was used to construct a comprehensive evaluation model of adolescent health status.Based on the description of the spatial-temporal distribution of the results,this paper explores the characteristics of spatial-temporal evolution of adolescent health and the convergence of changes.To construct a spatial-temporal weighted geographic regression model(GTWR),with economic,social,environmental and medical resource factors,to analyze the factors affecting the spatial and temporal distribution of adolescents,comprehensive health status.According to the analysis results and discussion,provide reference and policy recommendations to further improve the health management strategies of adolescents and improve their health.The specific research objectives are as follows:(1)To propose a comprehensive evaluation index system for adolescents in Shandong Province based on existing domestic and foreign literature research and AHM.(2)To describe the growth and development of adolescents in terms of body shape,physiological function,and physical illness,as well as trends in each indicator from 2014 to 2018.(3)To establish a comprehensive evaluation model for adolescent health based on genetic neural network.(4)To analyzes the spatial and temporal distribution patterns of adolescent health comprehensive evaluation scores in 17 cities in Shandong Province,reveals the temporal and spatial differences of adolescent health status and the trend of changes in convergence;further analyzes the influencing factors affecting the spatial and temporal distribution of adolescent health.(5)To present analysis results,give relevant advice,provide theoretical guidance and research reference in perfecting health management strategy for adolescent in Shandong Province.Data SourcesAccording to the research purpose,the research data mainly include:first,the data of adolescent physical examination in Shandong Province comes from the physical examination database of primary and secondary school students in Shandong Province from 2014 to 2018;second,the data of macro regional economic development,social development level,environmental quality and medical resources come from Shandong Statistical Yearbook.Research Contents and Methods(1)Summarize the main health problems faced by adolescents and the status of health assessment.The literature method and expert consultation method are used to study and analyze the literature related to adolescent health at home and abroad,and the literatures of the search and literature are collated and analyzed.(2)Construct a comprehensive evaluation index system for adolescent health status.Using the literature review and expert consultation method,the three categories of nine indicators that are most closely related to the physical health of adolescents are included.The AHM is used to establish the hierarchical structure of the system,construct the judgment matrix and calculate the relative weight and calculate the composite weight.Therefore,the weights of the first-and second-dimension indicators are determined,and a comprehensive evaluation index system for adolescent health status is constructed.(3)Describe the physical development and trends of adolescents from three aspects:adolescent body shape,physiological function and physical illness.Statistical description,ANOVA,chi-square test and other statistical analysis methods were used to compare adolescent health indicators of different genders,regions and years,and linear trend test was used to analyze the time trends of various health indicators.(4)Based on genetic neural network,a comprehensive evaluation model for adolescent health was constructed.Based on the experience of effective learning experts,BPNN is used to determine the network topology,and then the genetic algorithm is used to optimize the connection weight and threshold of BPNN,and the GA-BPNN comprehensive evaluation model is constructed.After the model is built and trained and verified,the model is fixed and then the overall health of the adolescent 1s evaluated.(5)Temporal-spatial analysis of adolescent health comprehensive evaluation results and analysis of influencing factors.The global and local spatial autocorrelation analysis is used to explore the heterogeneity of spatial distribution.The convergence test is used to analyze the convergence trend of adolescent health changes.The GTWR model is used to analyze the influencing factors affecting the spatial-temporal distribution of adolescent health.Main ResultsA total of 22,311,212 primary and secondary school students aged 10-18 years old were included in the study from2014 to 2018,including 52.9%for boys and 47.1%for girls,and rural accounted for 58.0%and urban accounted for 42.0%.(1)The morphological indicator.The results of five adolescent physical examinations from 2014 to 2018 showed that the BMI index of adolescents of different genders and regions increased gradually over the next five years,and the difference was statistically significant(P<0.001).The BMI of boys in each year was higher than that of girls,and the urban students were higher than those of rural students.The difference was statistically significant(P<0.001).In terms of age changes,the adolescent BMI index shows an increasing trend with age in all years,especially at the age of 10-14.From 2014 to 2018,the scores of body shape standards of adolescents of different genders and regions showed a downward trend year by year,and the difference was statistically significant(P<0.001).The standard scores of female students in each year were higher than those of male students,and the rural students were higher than urban students.The difference was statistically significant(P<0.001).(2)The Physiologicalfunction indicator:The trend of adolescents' weight-bearing vital capacity index was not obvious in 2014-2018.Only girls showed a slight fluctuation trend,and the difference between the years was statistically significant(P<0.001).Male students are higher than girls in different years,and the difference between urban and rural areas is not obvious.The scores of physiological function scores of adolescents in each year from 2014 to 2018 were statistically significant(P<0.001).The physiological function scores of girls basically fluctuated during the five years,while the scores of boys were not obvious.The standard scores of female students were higher than those of male students in each year,but there was no significant difference between urban and rural students.(3)The physical ailment indicator:? Overweight and Obesity.The overweight and obesity rates of adolescents from 2014 to 2018 showed a trend of increasing year by year(linear trend test,P<0.001),and the obesity rate reached 16.92%in 2018.The increase in overweight and obesity among girls is greater than that of boys,and rural students are larger than urban students.With the increase of age,the overweight and obesity rates of adolescents gradually decrease,and the overweight and obesity detection rate of adolescents aged 10-12 is higher than that of 13-15 years old and 16-18 years old.In terms of gender differences,both overweight and obesity rates were significantly higher in boys than in girls(P<0.001).Urban students were significantly higher than rural students(P<0.001).? Growth retardation and emaciation.In general,the detection rate of adolescent growth retardation and emaciation was low in 2014-2018.The detection rate of growth retardation and emaciation was higher in boys than in girls.The detection rate in rural students was higher than that of urban students.?High blood pr.essure.The detection rate of high blood pressure of male students in all years from 2018 to 2018 was higher than that of female students(P<0.001).The detection rate of rural students in 2014-2015 was higher than that of urban students.In 2016-2018,rural students began to be lower than urban students(P<0.001).In the past five years,the detection rate of high blood pressure among adolescents showed a trend of increasing year by year(linear trend test,P<0.001).The increase rate of high blood pressure of boys was higher than that of girls,and urban students were larger than rural students.The high blood pressure detection of adolescents with different nutritional status showed that the high blood pressure detection rate showed an increasing trend with moderate to severe weight loss,mild weight loss,normal,overweight and obesity,and the difference was statistically significant(P<0.001).?Dental caries.The detection rate of dental caries decreased significantly between 2014 and 2018.In 2018,it was down 5 percentage points from 2014.The detection rate of female dental caries was higher than that of male students in all years(P<0.001);rural students were generally higher than urban students(P<0.001).?Poor vision.Overall,the detection rate of poor vision showed a downward trend from 2014 to 2017,but it suddenly increased in 2018,suggesting that visual acuity still needs to be focused.The detection rate of poor vision increased with age,and the high school students had the highest detection rate of poor vision.More than 80%of girls and more than 75%of boys have the same age distribution in each year.The detection rate of girls with poor eyesight was significantly higher than that of boys(P<0.001),and the rate of poor eyesight detection among urban students was significantly higher than that of rural students(P<0.001).(4)Results of comprehensive evaluation of adolescent health.Overall,the scores of the comprehensive evaluation of adolescents from 2014 to 2018 showed a downward trend year by year.Compared with other years,the scores of adolescent health in 2018 decreased significantly.In each year,the adolescent health score showed a "V" shape trend,16 years old was the lowest evaluation score,and 17 and 18 years old rebounded.The female students were higher than the male students,and the rural students were higher than the urban students.The difference was statistically significant(P<0.001).From the spatial distribution point of view,the high zones of adolescent health scores are mainly distributed in the northwest and south of Shandong Province,while the health scores in Jiaodong Peninsula are relatively low,and the comprehensive health level of adolescents presents a clear ladder-like distribution from west to east.(5)Spatio-temporal evolution and influencing factors of adolescents'comprehensive evaluation scores.From 2014 to 2018,the health scores of adolescents in various cities of Shandong Province decreased significantly,and the degree of regional differences decreased.However,the basic pattern of "high in the west,low in the east and middle in the middle”did not change.The spatial distribution of health scores in different cities does not show complete randomness,but shows a certain spatial agglomeration on a macroscopic level.The regions with higher(lower)scores in comprehensive evaluation tend to be relatively higher(lower).Compared with 2014,the agglomeration trend of health scores in 2018 has been strengthened.After controlling the per capita GDP,urbanization rate,environmental quality,medical resources and other variables,the changes in health scores in various regions during the study period are convergent,indicating that the comprehensive health level of adolescents in each region is expected to gradually converge to a lower level or a higher level.Conclusions and SuggestionsMain conclusions:(1)The body shape and physiological functions of adolescents are generally in good condition.In addition to health problems such as overweight and obesity,myopia and dental caries,high blood pressure and even hypertension have become new threats to adolescent health.(2)The scores of the comprehensive assessment of adolescent health in 2014-2018 are fluctuating and generally show a downward trend.The degree of regional differences has been reduced,showing the basic pattern of“high in the west,low in the east and middle in the middle".(3)The distribution of comprehensive health level of adolescents in different regions does not show a complete randomness,and showing a certain trend of spatial agglomeration both globally and locally,but the trend of agglomeration weakens with the change of time,the difference of spatial distribution becomes smaller and more stable,and there is a clear convergence trend.(4)Regional economic development,social development status,residents' living standards,environmental quality,and medical and health resources have a significant impact on the comprehensive assessment of adolescent health.Suggestions:(1)Promoting the dissemination of the concept of "health first" and taking health priority as a guideline for promoting youth development.(2)Giving ftull play to the role of fanily education in promoting the health of adolescents and building "Healthy family"(3)Establishing "Health Promotion Schools" to play the leading role of school education in adolescent health education.(4)Aiming at the major health problems of different individual and group of students,to achieve precise force and classification policy.(5)Strengthening physical exercise and promote physical and mental health of students.(6)Regularly carrying out monitoring and evaluation of the health status of adolescents,and timely intervene to improve the inequality of the health level of adolescents.Innovations and LimitationsThe irnovations of this study:(1)Using the physical examination census data of primary and middle school students in Shandong Province from 2014 to 201 8,the relevant health indicators of all the respondents can be obtained.Compared with the sample survey data,the results are more accurate,and the research results are better representative significance(2)The AHM combined with GA-BPNN was used to construct a comprehensive evaluation model for adolescent health,the shortcomings of the previous AHP method that relied too much on expert experience and the BP neural network easily fall into local poles were made up,and simplifies the evaluation procedure and makes the evaluation process more scientific.(3)The panel data was used to analyze the spatial and temporal distribution characteristics of adolescent health assessment results and the temporal variation convergence.At the same time,a GTWR model was constructed to explore the factors affecting the spatial-temporal distribution of adolescent health status,which provided new ideas and directions for the subsequent research.The limitations of this study:(1)Limited by the availability of data,this study only included data from 2014-2018.Such short-panel data has a small-time dimension,and it is impossible to discuss whether there is autocorrelation in the disturbance item.(2)Only the impact of macro-social-economic factors,environmental factors and medical and health resources on the health of adolescents was analyzed,and the analysis of micro-influence factors is lacking. |
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