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Open Access Open Badges Research article

Changes in health risk behaviors of elementary school students in northern Taiwan from 2001 to 2003: results from the child and adolescent behaviors in long-term evolution study

Wen-Chi Wu1, Hsing-Yi Chang1, Lee-Lan Yen2* and Tony Szu-Hsien Lee3

Author Affiliations

1 Center for Health Policy Research and Development, National Health Research Institutes. No. 35, Keyan Road, Zhunan Town, Miaoli County 350, Taiwan, R.O.C

2 Institute of Health Policy and Management, College of Public Health, National Taiwan University. Rm. 623, No. 17, Xu-Zhou Road, Taipei 100, Taiwan, R.O.C

3 Department of Health Education, National Taiwan Normal University. 162 Sec. 1 Ho-Ping East Road, Taipei 106, Taiwan, R.O.C

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BMC Public Health 2007, 7:323  doi:10.1186/1471-2458-7-323

Published: 12 November 2007



Previous research has indicated that children's behaviors have long-term effects on later life. Hence it is important to monitor the development of health risk behaviors in childhood. This study examined the changes in health risk behaviors in fourth- to sixth-grade students in northern Taiwan from 2001 to 2003.


The Child and Adolescent Behaviors in Long-Term Evolution (CABLE) study collected data from 1,820 students from 2001 to 2003 (students were 9 or 10 years old in 2001). Exploratory factor analysis was used to determine the aggregation of health risk behaviors. A linear growth curve model was used to determine whether health risk behaviors changed over time.


Of the 13 behaviors, staying up late and eating snacks late at night were the most prevalent (82.3% of subjects in 2001, 81.8% in 2002, 88.5% in 2003) and second most prevalent (68.7%, 67.4%, 71.6%) behaviors, respectively, from 2001 to 2003. The three least prevalent health risk behaviors were chewing betel nut (1.0%, 0.4%, 0.2%), smoking (1.4%, 1.0%, 0.8%), and drinking alcohol (8.5%, 6.0%, 5.2%). The frequencies of swearing and staying up late showed the greatest significant increases with time. On the other hand, suppressing urination and drinking alcohol decreased over time. Using exploratory factor analysis, we aggregated the health risk behaviors into three categories: unhealthy habits, aggressive behaviors, and substance use. Although students did not display high levels of aggressive behavior or experimentation with substances, the development of these behaviors in a small proportion of students should not be ignored. The results of the linear growth curve model indicated that unhealthy habits and aggressive behaviors increased over time. However, substance use slightly decreased over time.


We found that some health risk behaviors increased with time while others did not. Unhealthy habits and aggressive behaviors increased, whereas substance use slightly decreased during this period. Educational professionals should pay attention to the different patterns of change in these behaviors in elementary school students.