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Child and Adolescent Behaviors in Long-term Evolution (CABLE)
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“Child and Adolescent Behaviors in Long-term Evolution (CABLE)” is a longitudinal study based on the ecological model and analyzes the multilevel influences from personal, family, school, and community facets on individual’s health and lifestyles. The research proposal was passed by the National Health Research Institutes’ advisory committee in January 2000 and was commenced in March. The acronym “CABLE” was chosen as the project logo in order to create a common term of reference among those in the research group and also for ease of communication when discussing the project with others. This logo was created from the first letter of each word of the study title. Cable, meaning electrical cable or broadband cable, is an essential item in modern daily life. This project incorporates certain basic qualities akin to those of cables such as length (long-term follow-up), heterogeneity (health is considered from the different perspectives of biology, psychology, and sociology), and breadth (the scope of the project includes individual, family, school and community factors).
CABLE is a prospective research project implemented from 2001 to 2014and was designed for at least two phases. The first phase of CABLE project was implemented between 2001 and 2005. The second phase has been conducted from 2006 to 2014. The annually repeated assessments in the first phase allow us to examine normal and pathogenic developments through childhood and early adolescence. The second phase observed and investigated the developmental trajectories of health status, health behaviors, mental health status, interpersonal relationships, school performance, and etc.
CABLE study provides empirical evidence in regard to the trends of children and adolescents’ health behaviors and health status, and associative factors. The results can contribute to guide the planning of health interventions, to improve the research and analysis method, and to provide information related to students’ health for policy making.
Purpose and Scope
The specific aims of CABLE study are:
1. to understand the distribution, aggregation and changes in health related behaviors of students in elementary school
2. to investigate the influence of parents on the health behavior and health status of student in elementary school
3. to elucidate individual, family and school factors that influence health behaviors of student
4. to explore the development of health status of students from biological, psychological and sociological perspectives
5. to understand career planning and the attitudes of marriage and childbearing in adulthood
It was decided to select first grade primary school students in 2001 as the sample population and follow them consecutively over the next few years. As the reformation of the education system has just been completed prior to 2001, this group of students is the first to experience the first to twelfth grade new education system. In order to gain an understanding of the different influences on student lifestyle and health status by the old and new educational systems, an additional study group of fourth graders was chosen. In addition, to compare differences between metropolitan and rural areas, the two locations of Taipei City and Hsinchu County were selected. In both Taipei and Hsinchu, a first grade and a fourth grade sample population was selected, giving a total of four sample groups for the two areas combined.
According to the study design, the first graders, called cohort 1, and the fourth graders, cohort 2, with their parents in 2001 are annually followed up for longitudinal analyses till the end of this project.
Two areas, Taipei City and Hsing-chu County, have been chosen for the comparison between urban and rural areas. There are 152 primary schools in Taipei City and 79 in Hsin-chu County. As there are only a few private primary schools in these two areas, and as the origin and family background of the students in these schools is quite dissimilar to the students in public schools, these private schools were excluded from the sample population. Based on the number of first grade students, schools were divided into small (50-199 students), medium-sized (200-399 students) and large (more than 400 students). Schools with less than 50 students were not included in the sample population due to insufficient numbers. After this, schools were randomly selected to participate in the survey. To ensure that the numbers of children chosen from each type of school was about equal it was decided to select 6 small schools, 2 medium-sized schools and 1 large school from each location.
An approximate estimate of student numbers was calculated as being 70 x 6 (small schools), 200 x 2 (medium-sized schools), and 400 x 1 (large school) giving a total of 1220 students. In addition, as two sets of students were chosen (a first grade and a fourth grade group) and there were two different locations, the overall number of students for the study was estimated as being 4880. In the advent that some schools would refuse to participate in the study, we randomly selected double the amount of schools required. The grade one and grade four students and their parents were then selected as the study sample from a combined total of 18 schools in the 2 areas. 3,584 first graders and 3,612 fourth graders were selected.
Content of the Questionnaires
The design of the CABLE study is based on the principles of the ecological model. The emphasis of the ecological model is that in-depth research should be carried out at different levels including individual, interpersonal, organizational, community and public policy. The research design incorporates the two major dependent variables such as health lifestyle and health behavior. The variable health lifestyle is composed of health harming behaviors, health protecting behaviors, and health promoting behaviors. The variable health status is assessed by the biological, psychological and sociological perspectives. The three major independent variables of individual factors (student and parental personal characteristics), interpersonal factors (the interpersonal relationships the student has at home and school), and organizational factors (the structure and function of the family, school and community), are also considered.
There are four different versions of the questionnaires that have been compiled for the different target groups including cohort 1 students, cohort 2 students, female caregivers and male caregivers. Both the student and parental/caregiver questionnaires include parts about basic personal and family information, inter-family relationships, and school life, as well as rating scales for health behavior, psychological health, and social health. The core concepts remained the same over each waves, but some changed depending on the developmental stage of students and current public health issues, such as puberty, physical maturity status, romantic relationships, bullying, and etc.
In order to explore the impacts of teachers’ attitudes and behaviors and also school environments on students’ health, a teacher’s questionnaire and school profile were collected in 2003. The students’ health indicator such as height, weight, eyesight, tooth status, and etc., students’ health information were gathered from the school health records.
CABLE data are collected through schools using in class self-fill in interviews, mail in surveys and household interview. In the initial stage, through the assistance of the school’s contact person, first grade and fourth grade student teachers distributed the informed consent forms for parents to complete. Only those students whose parents agreed to their participation in the study were included in the student sample group. A team of survey supervisors and interviewers went to the participated schools to collected data from September to November yearly. There were several university students recruited as trainers who were given interview training included introduction of the CABLE project; explanation of the contents of the questionnaires; explanation of the survey procedure; and any important points to keep in mind when conducting the survey. For students, they completed the questionnaires in classrooms under interviewers’ assistance. The interviewers gave the parent questionnaire to the students to take home as the completed student forms were being collected. The students were requested to give the questionnaire to their parents and hand in the completed and signed form to their class teacher the following day.
Till the students were in 7th grade, all participants in main junior high schools have been interviewed through school based survey, and for those who did not attend main school have been surveyed by mailing questionnaires. A questionnaire pack, including the respondent letter, student version of the questionnaire and a stamped addressed return envelope, mailed to the students’ permanent address in early October. After two weeks, a reminding postcard was sent to those who have not returned the questionnaires. Following another two weeks, the complete questionnaire pack was sent out again to those who have still not returned them.
After the joint senior high school entrance examination, some of students were in the different schools of different administrative divisions since they graduated from junior high schools. For those who are not attending senior high schools, some of them could start to work, and some of them even could get married. Hence, the Center of Survey of the Health Promotion Administration, Ministry of Health and Welfare in Taiwan provided help for the household interview with their professional training to gather adolescents’ information.
The 14th survey of the project was conducted in August 2014 to the end of December 2014. Till the end of 2014, this study has accumulated 13 years of longitudinal data. The analytical results can be reference for policy making and evaluation.