Nutrition-Exercise Behaviours and Heart Health: A Study on Secondary School Students

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In Turkey, this rate is 47%. Health-related attitudes and behaviors that are effective in the formation of CVDs that show symptoms in adulthood begin to develop in childhood. This research was conducted to evaluate the relationship between secondary school students' heart health promotion attitudes and nutrition-exercise behaviors. Methods The research was conducted as a descriptive-cross-sectional and correlation-seeking type study. Research data were collected using the “Sociodemographic Data Collection Form, “Children’s Cardiovascular Health Promotion Attitude Scale”and “Nutrition-Exercise Behavior Scale”. Within the scope of the research, 395 data were collected, Descriptive statistical methods (number, percentage, min-max values, mean, standard deviation) were used when evaluating the data. Results 51.8% of the students are girls, 35.3% are 12 years old, and 26.1% are 13 years old. Children's Cardiovascular Health Promotion Attitude Scale mean score was 27.13 ± 5.44; 6.86 ± 1.98 for Exercise Dimension; 7.98 ± 2.23 for Nutrition Dimension; It was calculated as 5.40 ± 1.79 for the Cigarette Dimension and 6.88 ± 2.10 for the Stress Control Dimension. Nutrition-Exercise Behavior Scale mean scores were 30.32 ± 9.14 for the Psychologically Dependent Eating Behavior subscale; 47.78 ± 10.14 for the Healthy Nutrition Exercise Behavior sub-dimension; 38.15 ± 7.64 for the Unhealthy Nutrition Exercise Behavior subscale; For the Meal Pattern sub-dimension, it was calculated as 21.35 ± 4.50. Conclusions While unhealthy nutrition, exercise behavior and psychologically dependent eating behavior positively affect attitude scores; healthy eating behavior and meal patterns negatively affect the scores. Health sciences/Cardiology Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Risk factors Cardiovascular health nutrition-exercise behavior secondary school students Introduction According to statistics from the World Health Organization (WHO), cardiovascular diseases (CVDs) rank as the leading cause of death globally, accounting for 32.6% of all deaths (WHO, 2023). Similarly, data from the Turkish Statistical Institute (TUIK) indicate that 36% of all deaths in Turkey are due to circulatory system diseases. When analysed according to specific causes, 41.5% of these deaths are attributed to ischaemic heart disease, 23.8% to other heart diseases, and 19.6% to cerebrovascular diseases (TUIK, 2023; WHO, 2023). There are both modifiable and non-modifiable risk factors for cardiovascular diseases. While age, sex, family history, and ethnicity are considered non-modifiable, smoking, insufficient physical activity, diabetes mellitus, obesity, hypertension, and a stressful lifestyle are modifiable risk factors (Ministry of Health, 2010; Tsao et al., 2023 ). The health-related behaviours and attitudes that contribute to the development of CVDs in adulthood typically begin to form during childhood. Once these lifestyle behaviours are established during childhood, they can be challenging to modify in adulthood (Bansal et al., 2023 ). Therefore, it is essential to instil positive health behaviours at an early age (Lechner et al., 2020 ; Zhu et al., 2023 ). While chronic conditions such as cardiovascular disease, type 2 diabetes, hypertension, or osteoporosis are not commonly seen in children and adolescents, a growing body of evidence indicates that many of these conditions originate in childhood (Hamilton-Ekeke, 2020; Lieberman, 2004; Swaminathan & Vaz, 2013 ). Preventing cardiovascular diseases involves establishing healthy dietary habits, maintaining appropriate levels of exercise, and promoting a general healthy lifestyle during childhood. Healthy eating, regular physical activity, and obesity prevention help reduce risk factors for heart disease. Acquiring sufficient nutritional knowledge and implementing it plays a key role in encouraging healthy eating habits among children (Gracey et al., 1996 ). In many developing countries, significant socioeconomic transformations have led to a nutritional transition. As a consequence, there has been an increasing tendency toward unhealthy eating habits. This shift has contributed to the rise of chronic diseases such as obesity and associated cardiovascular diseases (Musaiger et al., 2016 ). Several studies report that adolescents’ eating habits are undergoing rapid changes; they eat less systematically, consume more meals outside the home, and are influenced by their social environment, including family and friends. Additionally, they often skip breakfast, replace lunch with snacks, and consume more sugary beverages, all of which are considered unhealthy eating behaviours (Michels et al., 2018 ; Musaiger et al., 2016 ; Rakicioglu & Akal Yildiz, 2011). In addition to diet, regular exercise plays a crucial role in preventing diseases such as cardiovascular disorders, obesity, and diabetes (Rusdiawan et al., 2024 ). Regular physical activity in children and adolescents improves overall health and physical fitness. Physically active children exhibit higher cardiorespiratory fitness, lower fat accumulation, and stronger muscles and bones compared to their inactive peers (de Rezende et al., 2015 ). Physical inactivity increases the risk of obesity, cardiovascular diseases, and diabetes. Moreover, engaging in regular exercise positively influences children’s mental health and stress perception, reducing psychological issues such as depression and improving overall health (Fox & Hillsdon, 2007 ; Greenspan et al., 2021 ; VanKim & Nelson, 2013 ). However, the absence of adequate programmes aimed at reducing the likelihood of risk factor development, as well as factors such as school or work, are barriers that limit children’s ability to participate in physical activities (Baddou et al., 2018 ; Perry & Hoffman, 2010 ). Creating spaces where school-aged children and adolescents can engage in physical activity is vital for cultivating positive health behaviours (Santos et al., 2022). Modifying behaviour requires identifying attitudes related to the behaviour and transforming them in a positive direction. School nurses play a critical role in this process. By controlling biological, environmental, and socio-cultural influences, they can provide preventive and promotive health services to individuals, families, and communities, thereby encouraging positive behaviours. Nurses can help change negative attitudes through health education programmes emphasising the importance of nutrition and physical activity for heart health (Ozturk Haney & Bahar, 2014 ; Robinson & Thomas, 2004 ). Healthy dietary habits and appropriate physical activity levels during childhood are essential for preventing cardiovascular diseases, obesity-related diabetes, and hypertension (Fazel et al., 2014 ). This study aimed to examine the relationship between cardiovascular health promotion attitudes and nutrition-exercise behaviours among secondary school students. Methods Study Design This research employed a descriptive, cross-sectional, and correlational design. Population and Sample The study population consisted of three public secondary schools affiliated with the Zonguldak Provincial Directorate of National Education, selected by lottery. These schools had a total student population of 3,000. Based on a 95% confidence interval and a 5% margin of error, the required sample size was calculated as 350 students. Data were collected from 395 students; however, after excluding 15 participants due to outliers and extreme values, the final analysis included data from 380 students. Students were informed about the study before its initiation. Those who agreed to participate were included in the study, and written and verbal informed consent was obtained from them. As the children were under 18 years of age, an informed consent form indicating parental permission for participation in the study was sent home via the children, and written parental consent was obtained. Inclusion Criteria Being enrolled in one of the selected schools, Consent to participate from both the student and their guardian, No cognitive impairments. Data Collection Tools Data were collected between 1st September and 31st December 2023 using a “Socio-Demographic Data Collection Form,” the “Children’s Cardiovascular Health Attitude Scale (CCHPAS),” and the “Nutrition–Exercise Behaviour Scale (NEBS).” Socio-Demographic Data Collection Form A ten-item form collecting data on students’ age, sex, and parental education levels. Children’s Cardiovascular Health Promotion Attitude Scale (CCHPAS) : Developed by Arvidson ( 1990 ), this 16-item 4-point Likert-type scale measures attitudes in four domains: stress control, smoking, nutrition, and exercise. The Turkish validity and reliability study was conducted by Ozturk Haney (2002). Scores for each sub-dimension range from 4 to 16, and total scores range from 16 to 64, with higher scores indicating more positive attitudes toward heart health. The overall Cronbach’s alpha of the scale is 0.80, with sub-dimensions ranging between 0.76 and 0.63 (Ozturk Haney & Bahar, 2014 ). The Cronbach’s alpha values calculated in the current study are presented in Table 1 . Nutrition Exercise Behaviour Scale (NEBS) Developed by Yurt ( 2008 ), this 5-point Likert scale consists of four sub-dimensions. The psychological eating behaviour subscale ranges from 11 to 55, with higher scores indicating a higher risk of psychological eating behaviour. The healthy and unhealthy nutrition-exercise behaviour subscales range from 14 to 70, where higher scores reflect stronger adherence to each respective behaviour. The meal pattern subscale ranges from 6 to 30, with higher scores suggesting better meal regularity. The overall Cronbach’s alpha is 0.85, with sub-dimensions ranging between 0.61 and 0.73. Reliability analysis results are also provided in Table 1 . Table 1 Reliability Analysis Results for the Measurement Instruments Scales Cronbach’s Alpha Children’s Cardiovascular Health Promotion Attitude Scale Exercise Subscale Nutrition Subscale Smoking Subscale Stress Control Subscale 0.73 0.72 0.61 0.67 0.65 Nutrition Exercise Behaviour Scale Psychological Eating Behaviour Subscale Healthy Nutrition-Exercise Behaviour Subscale Unhealthy Nutrition-Exercise Behaviour Subscale Meal Pattern Subscale 0.79 0.80 0.62 0.63 Data Analysis The collected data were analysed using SPSS (Statistical Package for the Social Sciences) for Windows, version 25.0. Descriptive statistical methods were employed, including frequency, percentage, minimum–maximum values, mean, and standard deviation. Cronbach’s alpha coefficients were calculated to assess the reliability of the scales used in the study. To evaluate the normal distribution of continuous variables, skewness and kurtosis values were examined to ensure they fell within the ± 3 range. Prior to testing normality, outlier analysis was conducted to remove extreme observations. Parametric tests were applied to variables with normal distribution. Pearson correlation analysis was used to investigate the relationships between continuous variables. Additionally, multiple linear regression analysis was conducted to determine the influence of independent variables on dependent variables. Results Table 2 Demographic Characteristics of the Participants Characteristics Age Mean ± SD 11.78 ± 0.93 n % Gender Female Male 197 183 51.8 48.2 Grade Level 5th Grade 6th Grade 7th Grade 124 141 115 32.6 37.1 30.3 Mother’s Educational Level Primary School Graduate Secondary School Graduate High School Graduate University Graduate 42 65 137 136 11.1 17.1 36.1 35.8 Mother’s Occupation Homemaker Worker Civil Servant Self-Employed 229 30 92 29 60.3 7.9 24.2 7.6 Father’s Educational Level Primary School Graduate Secondary School Graduate High School Graduate University Graduate 36 63 143 138 9.5 16.6 37.6 36.3 Father’s Occupation Civil Servant Worker Self-Employed Retired 136 117 100 27 35.8 30.8 26.3 7.1 Family’s Economic Status Income less than Expenses Income equal to Expenses Income more than Expenses 16 236 128 4.2 62.1 33.7 Family Type Nuclear Family Extended Family Single-Parent Family 296 55 29 77.9 14.5 7.6 The average age of the participating students was 11.78 ± 0.93 years. Of these students, 51.8% were female. It was found that 35.8% of the mothers held a university degree, and 60.3% were homemakers. Regarding paternal education, 37.6% had completed high school, and 35.8% were civil servants. In terms of family structure, 62.1% reported income equal to expenses, and 77.9% lived in a nuclear family (Table 2 ). Table 3 Descriptive Statistics for the Scales Scale / Subscales Min Max Mean SD CCHPAS Total Score 16.00 42.00 27.13 5.44 Exercise Subscale Nutrition Subscale Smoking Subscale Stress Control Subscale 4.00 4.00 4.00 4.00 12.00 14.00 10.00 13.00 6.86 7.98 5.40 6.88 1.98 2.23 1.79 2.10 NEBS Psychological Eating Behaviour Subscale Healthy Nutrition-Exercise Behaviour Subscale Unhealthy Nutrition-Exercise Behaviour Subscale Meal Pattern Subscale 11.00 23.00 18.00 9.00 55.00 70.00 59.00 30.00 30.32 47.78 38.15 21.35 9.14 10.14 7.64 4.50 Table 3 presents the minimum and maximum scores, mean, and standard deviation values for the scale scores. Table 4 Correlations Between the Scales Scale/Subscales NEBS Psychological Eating Behaviour r p Healthy Nutrition-Exercise Behaviour r p Unhealthy Nutrition-Exercise Behaviour r p Meal Pattern r p CCHPAS − .207 ** 0.0001 .566 ** 0.0001 − .105 * 0.042 .505 ** 0.0001 Exercise 0.092 0.074 .518 ** 0.0001 -0.041 0.430 .277 ** 0.0001 Nutrition − .202 ** 0.0001 .460 ** 0.0001 -0.079 0.126 .451 ** 0.0001 Smoking 0.097 0.059 .164 ** 0.002 .204 ** 0.320 .256 ** 0.0001 Stress Control .151 ** 0.003 .347 ** 0.0001 0.051 0.319 .348 ** 0.0001 r: Pearson correlation coefficient ; *p < 0.05; **p < 0.01 An analysis of the relationships between scales revealed several statistically significant correlations. A weak, negative correlation was found between the CCHPAS scores and the NEBS psychological eating behaviour subscale (r = -0.207, p = 0.000). A moderate, positive correlation was observed between CCHPAS scores and the healthy nutrition-exercise behaviour subscale (r = 0.566, p = 0.000). A weak, negative correlation emerged with the unhealthy nutrition-exercise behaviour subscale (r = -0.105, p = 0.042), and a moderate, positive correlation with the meal pattern subscale (r = 0.505, p = 0.000). There was also a moderate, positive correlation between the exercise subdimension of CCHPAS and the healthy nutrition-exercise behaviour subscale of NEBS (r = 0.518, p = 0.000), along with a weak, positive correlation with the meal pattern subscale (r = 0.277, p = 0.000). A weak, negative correlation was detected between the nutrition subdimension of CCHPAS and the psychological eating behaviour subscale of NEBS (r = -0.202, p = 0.000). In contrast, moderate, positive correlations were noted with the healthy nutrition-exercise behaviour (r = 0.460, p = 0.000) and meal pattern (r = 0.451, p = 0.000) subscales. The smoking subdimension of CCHPAS showed weak, positive correlations with both the healthy nutrition-exercise behaviour (r = 0.164, p = 0.002) and meal pattern (r = 0.256, p = 0.000) subscales. Similarly, the stress control subdimension was weakly and positively correlated with the psychological eating behaviour (r = 0.151, p = 0.003), healthy nutrition-exercise behaviour (r = 0.347, p = 0.000), and meal pattern (r = 0.348, p = 0.000) subscales (Table 4 ). Table 5 Multiple Linear Regression Analysis Explaining Children’s Cardiovascular Health Promotion Attitude Levels Unstandardised t p-value VIF value F-value Model p-value Adjusted R 2 Beta Std. Error Constant 41.630 1.593 26.135 0.000 48.414 0.000 0.429 Psychological Eating Behaviour -0.056 0.028 2.002 0.046 1.464 Healthy Nutrition-Exercise Behaviour 0.220 0.025 -8.881 0.000 1.414 Unhealthy Nutrition-Exercise Behaviour -0.067 0.033 2.008 0.045 1.440 Meal Pattern 0.329 0.056 -5.871 0.000 1.426 Grade (Reference: 7th Grade) 5th Grade -1.932 0.553 -3.494 0.001 1.512 6th Grade -1.584 0.524 -3.024 0.003 1.440 A multiple linear regression analysis was conducted to identify the nutritional and exercise behaviours and personal characteristics that influenced children’s attitudes toward cardiovascular health promotion. Initially, variables with statistically significant differences in socio-demographic comparisons and significant correlations between NEBS subdimensions and CCHPAS scores were selected as independent variables for the regression model. The model was statistically significant overall (F = 48.414, p = 0.000). The independent variables collectively explained 42.9% of the variance in CCHPAS scores (Adjusted R² = 0.429). According to the model, unhealthy nutrition-exercise behaviour and psychological eating behaviour had negative effects on attitude scores, whereas healthy nutrition-exercise behaviour and regular meal patterns had positive effects. Furthermore, the attitude scores of fifth-grade students were significantly lower than those of seventh-grade students (β = -1.932), as were the scores of sixth-grade students (β = -1.584) (Table 5 ). Discussion Changes in individual lifestyle habits form the first step in reducing the population-wide risk of cardiovascular diseases. Although implementing such changes may be challenging, they remain among the most cost-effective and side-effect-free preventive strategies (Aydın, Oflu & Yalçın, 2021 ). When considering lifestyle changes, dietary and exercise behaviours are typically the most prominent components (Chang et al., 2022 ). A study demonstrated that many modifiable risk factors for cardiovascular diseases stem from unhealthy habits and attitudes acquired during childhood and that up to 80% of these diseases can be prevented by promoting healthy eating and exercise habits (Carter et al., 2019 ). Cardiovascular health-promoting attitudes acquired in childhood are highly effective in reducing risk factors that may emerge during adulthood (Rouzbahani et al., 2009 ). In our study, the relationship between secondary school students’ cardiovascular health attitudes and their nutrition-exercise behaviours was assessed using the CCHPAS and NEBS, and statistically significant results were observed across various subdimensions. When the scores of the NEBS subdimensions (healthy nutrition-exercise behaviour, unhealthy nutrition-exercise behaviour, and meal pattern) in this study are compared with those reported in the literature, similar mean scores were noted in studies conducted by Akan ( 2018 ), Yurt and Yıldız ( 2016 ), and Ayaz Alkaya and Kulakçı Altıntaş (2021). However, the psychological (dependent) eating behaviour subscale scores among adolescents in our study were lower. This finding indicates that adolescents in this study exhibited lower levels of psychological eating behaviour and more positive eating patterns. Furthermore, as scores for psychological eating behaviour decreased, attitudes toward promoting heart health improved. These results suggest that children’s attitudes toward heart health and nutrition-exercise behaviours vary across subdimensions and highlight the potential for improvement in meal regularity. These findings hold significant importance considering the long-term impact of lifestyle habits on children’s health. CCHPAS total scores were negatively influenced by unhealthy nutrition-exercise and psychological eating behaviour, whereas healthy nutrition-exercise and meal pattern scores had a positive impact. Akan ( 2018 ) found that adolescents who engaged in regular exercise had higher average scores for healthy and unhealthy nutrition-exercise behaviours than those who did not exercise. However, adolescents who did not exercise regularly showed higher scores in the meal pattern subdimension. Bebiş et al. ( 2021 ) also reported that adolescents who engaged in sports exhibited more positive nutrition and exercise behaviours than those who did not. Enhancing physical activity requires a holistic, multisectoral, and culturally informed approach at both individual and societal levels (Ministry of Health, 2014). As obesity continues to escalate into a major public health concern globally and nationally, international organisations like the WHO, along with many national bodies, have implemented a range of strategies, such as promoting balanced nutrition and active lifestyles through various programmes and action plans (Altıncı et al., 2016 ). This study also revealed that fifth- and sixth-grade students had lower attitude scores compared to seventh-grade students. This aligns with similar findings in the literature (Ayaz Alkaya & Kulakçı Altıntaş, 2021; Montelpare et al., 2018 ). In Akan’s ( 2018 ) study, 11-year-old adolescents had significantly higher scores in the healthy nutrition-exercise subdimension than those in other age groups, while 12-year-olds had higher scores than 14-year-olds. Tümer et al. ( 2014 ) found that as age increased among middle school students, healthy nutrition and exercise behaviours declined. Demirezen and Coşansu ( 2005 ) observed that the level of nutritional risk increased with age in adolescents. Aksoydan and Çakır ( 2011 ) reported that students’ frequency of eating at the school canteen decreased, and fast food consumption increased with educational level. A study examining adolescents’ eating habits, physical activity levels, and body mass index across different education stages revealed a decrease in regular meal consumption, an increase in meal skipping, fast food consumption, and eating outside the school canteen. Breakfast was the most frequently skipped meal, and girls were found to skip meals and eat at school canteens more often than boys. The number of overweight students also increased with educational level (Akın & Sani Bozkurt, 2020; Aksoydan & Çakır, 2011 ). These changes in dietary habits may be linked to shifts in social settings, lifestyle, and environmental factors. As adolescents grow older, they tend to spend more time with peers outside the home, eat out more frequently, and have easier access to snacks, which may explain these adverse changes in dietary habits. Health behaviours learned during childhood are more likely to become integrated into personal lifestyles and are more enduring compared to those acquired in adulthood. School-aged children are expected to take responsibility for and manage health behaviours such as nutrition and physical activity (Eo & Kim, 2019 ). Ayaz Alkaya and Kulakçı Altıntaş (2021) found that adolescents displayed moderate levels of healthy nutrition and exercise behaviours. Similar findings were reported by Hendekçi and Aydın Avcı (2020) and Kalay and Sonay Türkmen (2015). Poor dietary habits and insufficient physical activity are major contributors to the development of chronic diseases such as cardiovascular disease, diabetes, and cancer. Regular physical activity provides long-term health benefits for children and adolescents by improving cardiovascular fitness, enhancing bone mass, and promoting mental well-being (Pender, 2015). Therefore, adopting healthy lifestyle behaviours, including balanced nutrition and regular exercise, from an early age is essential for protecting and improving adolescent health. Nutrition and physical activity programmes are effective tools in fostering these habits among children and adolescents. Implication for practice The results of this study suggest several actionable strategies for pediatric nurses and healthcare professionals working with adolescents. Given the complex relationship between heart health attitudes and nutrition-exercise behaviours, pediatric nurses play a vital role in both education and advocacy to support healthy lifestyle development. Specifically: Early and consistent health education is critical. Pediatric nurses can advocate for and participate in implementing nutrition and physical activity education beginning in early childhood and continuing throughout the school years. Parental and community involvement is essential. Pediatric nurses should encourage family-centered approaches and contribute to school-based nutrition education programs that actively involve caregivers. Nurses should be involved in ongoing professional development related to adolescent nutrition and health promotion to ensure up-to-date, evidence-based guidance is provided. Further research with larger, diverse populations is needed to tailor interventions to regional and cultural needs, and pediatric nurses can contribute to and lead these efforts. By integrating these strategies into pediatric nursing practice, professionals can help transform positive health attitudes into sustainable, heart-healthy behaviours among adolescents. Conclusion The relationship between attitudes toward heart health and nutrition-exercise behaviours is complex. While possessing positive health attitudes can facilitate the adoption of healthy behaviours, individual and environmental factors may influence this process. Programmes designed to promote cardiovascular health should not only enhance individuals’ attitudes but also support the transformation of these attitudes into sustainable behaviours. Thus, strengthening attitudes related to heart health and fostering supportive social environments play a vital role in the widespread adoption of healthy lifestyles. Regular and balanced dietary habits, along with consistent physical activity, are among the most important factors for maintaining and improving health. The formation of healthy lifestyle habits during adolescence can be achieved through nutrition education that begins in childhood and continues throughout formal education. Incorporating basic nutrition education into curricula at all levels of schooling, utilising engaging methods such as stories, films, and short plays, and providing in-service training to teachers about the latest developments in nutrition can help sustain these educational efforts. Establishing school-based nutrition education centres to educate families and maintaining continuous cooperation among teachers, students, and parents will contribute significantly to the effectiveness and long-term success of these interventions. Given the findings of this study, it is recommended that future research with larger sample sizes be conducted in different regions to explore the relationship between adolescents’ nutrition-exercise behaviours, body mass index, and the influencing factors in greater depth. This would help further clarify regional differences and support the development of more targeted and effective interventions. Declarations Ethical considerations Before the study commenced, written approval was obtained from Zonguldak Bulent Ecevit University Ethics Committee for Human Research (first decision dated 27.3.2023, number 289688 and then the ethics committee decision was renewed with the date and number 04.07.2025/620925) and from the institutions where the research was conducted. Before participation, the students received written information stating that their data would be used for scientific purposes and their identities would be kept confidential. The study adhered to the principles of the Declaration of Helsinki. Data availability The data can be shared upon request from the authors. Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Author Contribution TKA: Writing–review & editing, Writing original draft, Visualization, Validation, Supervision, Project administration, Methodology, Investigation, Formal analysis. IBA: Writing–review & editing, Writing–original draft, Visualization, Supervision, Investigation, Conceptualization. MB: Project administration, Formal analysis, Conceptualization, Data curation. Acknowledgement This study was funded by the Scientific and Technological Research Council (TÜBİTAK) under the 2209-A Program for Supporting Research Projects of Undergraduate Students, so we thank to TUBİTAK for supporting the Project and all the participants. References Akan M (2018) Adölesanlarda beslenme egzersiz davranışları ile beden kitle indeksi arasındaki ilişki. 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Ankara Med J, 20(2), 315–326 Kalay R, Türkmen AS (2015) Adölesanlarda beslenme ve egzersiz davranışlarını etkileyen faktörlerin belirlenmesi. Uluslararası Hakemli Beslenme Araştırmaları Dergisi, (5), 1–14 Lechner K, von Schacky C, McKenzie AL, Worm N, Nixdorff U, Lechner B, Kränkel N, Halle M, Krauss RM, Scherr J (2020) Lifestyle factors and high-risk atherosclerosis: Pathways and mechanisms beyond traditional risk factors. Eur J Prev Cardiol 27(4):394. https://doi.org/10.1177/2047487319869400 Michels N, Vynckier L, Moreno LA, Beghin L, de la OA, Forsner M, De Henauw S (2018) Mediation of psychosocial determinants in the relation between socio-economic status and adolescents' diet quality. Eur J Nutr Food Saf 57(3):951–963 Montelpare WJ, McPherson MN, Boardman K, Zerpa CE (2018) Evaluating the wizards of motion cardiovascular disease prevention module. J School Nurs 34(5):350–358. https://doi.org/10.1177/1059840517709074 Musaiger AO, Al-Khalifa F, Al-Mannai M (2016) Obesity, unhealthy dietary habits and sedentary behaviors among university students in Sudan: Growing risks for chronic diseases in a poor country. Environ Health Prev Med 21(4):224–230 Pender NJ, Murdaugh CL, Parsons MA (2015) Health Promotion in Nursing. Upper Saddle Rive, NJ, Pearson Education Perry CK, Hoffman B (2010) Barriers to physical activity in adolescents: A systematic review. J Adolesc Health 47(2):126–134. https://doi.org/10.1016/j.jadohealth.2010.01.017 Rakıcıoğlu N, Akal Yıldız E (2011) Energy and nutrient intake and food patterns among Turkish university students. Nutr Res Pract 5(2):117–123 Robinson S, Thomas SP (2004) The role of school nurses in promoting healthy behavior in children. J Sch Nurs 20(4):202–208. https://doi.org/10.1177/10598405040200040301 Rouzbahani R, Rouzbahani A, Rouzbahani H, Barkhor-dar M, Rouzbahani F, Rezaei M, Rezaei F, Ahmadi RM, M (2009) Promotion of healthy heart knowledge and attitude in elementary school students in Shahrekord, Iran. ARYA Atherosclerosis J 5(2):64–68 Rusdiawan D, Abdullah R, Dewi NMS, Prasetyo B (2024) The synergistic effects of physical exercise and healthy diet in preventing non-communicable diseases: A review. J Prev Med Public Health 57(1):1–10. https://doi.org/10.3961/jpmph.23.125 Santos-Beneit G, Fernández-Jiménez R, de Cos-Gandoy A et al (2022) Lessons learned from 10 years of preschool intervention for health promotion: JACC state-of-the-art review. J AmColl Cardiol 79(3):283–298. 10.1016/j.jacc.2021.10.046 Swaminathan S, Vaz M (2013) Childhood physical activity, sports and exercise and noncommunicable disease: A special focus on India. Indian J Pediatr 80(1):63–70 T.C. Sağlık Bakanlığı. Türkiye fiziksel aktivite rehberi/çocuk ve ergenlerde fiziksel akitivite. Sağlık Bakanlığı Yayınları. Ankara: (2014) http://fizikselaktivite.gov.tr/wpcontent/uploads/CocukveErgenlerdeFizikselAktivite.pdf Erişim Tarihi: 05.08.2024 Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Martin SS (2023) Heart disease and stroke statistics-2023 Update: A report from the American Heart Association. Circulation 147(8):E93–E621. https://doi.org/10.1161/CIR.0000000000001123 Tümer A, Gök F, Evren M (2014) Ortaokul öğrencilerinin beslenme ve egzersiz davranışlarının incelenmesi. 17. Ulusal Halk Sağlığı Kongre Kitabı s.1305, Edirne, 2014 Türkiye İstatistik Kurumu (TÜİK) (2023), August 15 Ölüm ve ölüm nedeni istatistikleri, 2020 VanKim NA, Nelson TF (2013) Vigorous physical activity, mental health, perceived stress, and socializing among college students. Am J Health Promotion 28(1):7–15. https://doi.org/10.4278/ajhp.111101-QUAN-395 WHO (2018) Obesity and overweight. Erişim adresi: https://www.who.int/news-room/fact- sheets/detail/obesity-and-overweight . Erişim tarihi: August,2024. Yurt S (2008) Fazla kilolu adölesanlara uygulanan motivasyon görüşmelerinin beslenme tutumu, davranışları ve kilo üzerine etkisi. Doktora tezi. Marmara Üniversitesi Sağlık Bilimleri Enstitüsü. İstanbul Yurt S, Yıldız A (2016) Fazla kilolu adölesanlara uygulanan motivasyon görüşmelerinin beslenme tutumu, davranışları ve kilo üzerine etkisi. J Public Health Nurs-Special Top 2(1):7–13 Zhu Y, Gu L, Li J (2023) Education changes child health behavior in China: A mediating role of information technology. Am J Health Behav 47(2):408–419. https://doi.org/10.5993/AJHB.47.2.20 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8248194","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":593858373,"identity":"f21d5bdc-e147-4d71-a22d-7d828486a30b","order_by":0,"name":"Tülay Kuzlu Ayyıldız","email":"","orcid":"","institution":"Zonguldak Bülent Ecevit University","correspondingAuthor":false,"prefix":"","firstName":"Tülay","middleName":"Kuzlu","lastName":"Ayyıldız","suffix":""},{"id":593858374,"identity":"c6352592-2611-417d-926c-7a210cf57976","order_by":1,"name":"Işın Bıyıkoğlu Alkan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+0lEQVRIiWNgGAWjYBACNgbGBmYGAwYeCQYGxgMMFUAhZuYGorUwHGA4A9LCiF8LCDCDCLAWxjYQk4AWPv7DbY8LCg7LSLa3XzjMO682mr8dqOVHxTbcDpNIbDeeYXCYR5rnTMFh3m3Hc2ccZmxg7DlzG48WxjZpHqAWOYmcBKCWY7kNQC3MjG14tPAfRNYy51jufIJaGBIhWqQl0g8c5m2oyd1AUIsEUMsMg3QeyZ4zDAfnHDuQuxGo5SA+v8j3H38mXfDH2l7iePvDB29q6nLnnT988MGPCtxaoKAZiHkMgMRhMPcAIfVAUAfE7A+gjFEwCkbBKBgFqAAAyLJZI4iCIkYAAAAASUVORK5CYII=","orcid":"","institution":"Zonguldak Bülent Ecevit University","correspondingAuthor":true,"prefix":"","firstName":"Işın","middleName":"Bıyıkoğlu","lastName":"Alkan","suffix":""},{"id":593858375,"identity":"0c590ef2-6f9f-4946-bd0b-2a90ba8bef53","order_by":2,"name":"Merve Boynaz","email":"","orcid":"","institution":"Zonguldak Bülent Ecevit University","correspondingAuthor":false,"prefix":"","firstName":"Merve","middleName":"","lastName":"Boynaz","suffix":""}],"badges":[],"createdAt":"2025-12-01 08:53:42","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8248194/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8248194/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109202257,"identity":"9ee721b0-aefe-4063-9a8d-280d10eb6f11","added_by":"auto","created_at":"2026-05-13 13:59:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":354563,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8248194/v1/a9c2f126-07a3-4dc1-b2de-dbfe117e07f9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Nutrition-Exercise Behaviours and Heart Health: A Study on Secondary School Students","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAccording to statistics from the World Health Organization (WHO), cardiovascular diseases (CVDs) rank as the leading cause of death globally, accounting for 32.6% of all deaths (WHO, 2023). Similarly, data from the Turkish Statistical Institute (TUIK) indicate that 36% of all deaths in Turkey are due to circulatory system diseases. When analysed according to specific causes, 41.5% of these deaths are attributed to ischaemic heart disease, 23.8% to other heart diseases, and 19.6% to cerebrovascular diseases (TUIK, 2023; WHO, 2023).\u003c/p\u003e \u003cp\u003eThere are both modifiable and non-modifiable risk factors for cardiovascular diseases. While age, sex, family history, and ethnicity are considered non-modifiable, smoking, insufficient physical activity, diabetes mellitus, obesity, hypertension, and a stressful lifestyle are modifiable risk factors (Ministry of Health, 2010; Tsao et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The health-related behaviours and attitudes that contribute to the development of CVDs in adulthood typically begin to form during childhood. Once these lifestyle behaviours are established during childhood, they can be challenging to modify in adulthood (Bansal et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Therefore, it is essential to instil positive health behaviours at an early age (Lechner et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Zhu et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). While chronic conditions such as cardiovascular disease, type 2 diabetes, hypertension, or osteoporosis are not commonly seen in children and adolescents, a growing body of evidence indicates that many of these conditions originate in childhood (Hamilton-Ekeke, 2020; Lieberman, 2004; Swaminathan \u0026amp; Vaz, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePreventing cardiovascular diseases involves establishing healthy dietary habits, maintaining appropriate levels of exercise, and promoting a general healthy lifestyle during childhood. Healthy eating, regular physical activity, and obesity prevention help reduce risk factors for heart disease. Acquiring sufficient nutritional knowledge and implementing it plays a key role in encouraging healthy eating habits among children (Gracey et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e1996\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn many developing countries, significant socioeconomic transformations have led to a nutritional transition. As a consequence, there has been an increasing tendency toward unhealthy eating habits. This shift has contributed to the rise of chronic diseases such as obesity and associated cardiovascular diseases (Musaiger et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Several studies report that adolescents\u0026rsquo; eating habits are undergoing rapid changes; they eat less systematically, consume more meals outside the home, and are influenced by their social environment, including family and friends. Additionally, they often skip breakfast, replace lunch with snacks, and consume more sugary beverages, all of which are considered unhealthy eating behaviours (Michels et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Musaiger et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Rakicioglu \u0026amp; Akal Yildiz, 2011).\u003c/p\u003e \u003cp\u003eIn addition to diet, regular exercise plays a crucial role in preventing diseases such as cardiovascular disorders, obesity, and diabetes (Rusdiawan et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Regular physical activity in children and adolescents improves overall health and physical fitness. Physically active children exhibit higher cardiorespiratory fitness, lower fat accumulation, and stronger muscles and bones compared to their inactive peers (de Rezende et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Physical inactivity increases the risk of obesity, cardiovascular diseases, and diabetes. Moreover, engaging in regular exercise positively influences children\u0026rsquo;s mental health and stress perception, reducing psychological issues such as depression and improving overall health (Fox \u0026amp; Hillsdon, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Greenspan et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; VanKim \u0026amp; Nelson, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). However, the absence of adequate programmes aimed at reducing the likelihood of risk factor development, as well as factors such as school or work, are barriers that limit children\u0026rsquo;s ability to participate in physical activities (Baddou et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Perry \u0026amp; Hoffman, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2010\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCreating spaces where school-aged children and adolescents can engage in physical activity is vital for cultivating positive health behaviours (Santos et al., 2022). Modifying behaviour requires identifying attitudes related to the behaviour and transforming them in a positive direction. School nurses play a critical role in this process. By controlling biological, environmental, and socio-cultural influences, they can provide preventive and promotive health services to individuals, families, and communities, thereby encouraging positive behaviours. Nurses can help change negative attitudes through health education programmes emphasising the importance of nutrition and physical activity for heart health (Ozturk Haney \u0026amp; Bahar, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Robinson \u0026amp; Thomas, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2004\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHealthy dietary habits and appropriate physical activity levels during childhood are essential for preventing cardiovascular diseases, obesity-related diabetes, and hypertension (Fazel et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). This study aimed to examine the relationship between cardiovascular health promotion attitudes and nutrition-exercise behaviours among secondary school students.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003eStudy Design\u003c/h2\u003e\n\u003cp\u003eThis research employed a descriptive, cross-sectional, and correlational design.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003ePopulation and Sample\u003c/h3\u003e\n\u003cp\u003eThe study population consisted of three public secondary schools affiliated with the Zonguldak Provincial Directorate of National Education, selected by lottery. These schools had a total student population of 3,000. Based on a 95% confidence interval and a 5% margin of error, the required sample size was calculated as 350 students. Data were collected from 395 students; however, after excluding 15 participants due to outliers and extreme values, the final analysis included data from 380 students. Students were informed about the study before its initiation. Those who agreed to participate were included in the study, and written and verbal informed consent was obtained from them. As the children were under 18 years of age, an informed consent form indicating parental permission for participation in the study was sent home via the children, and written parental consent was obtained.\u003c/p\u003e\n\u003ch3\u003eInclusion Criteria\u003c/h3\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eBeing enrolled in one of the selected schools,\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eConsent to participate\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003efrom both the student and their guardian,\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eNo cognitive impairments.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch3\u003eData Collection Tools\u003c/h3\u003e\n\u003cp\u003eData were collected between 1st September and 31st December 2023 using a \u0026ldquo;Socio-Demographic Data Collection Form,\u0026rdquo; the \u0026ldquo;Children\u0026rsquo;s Cardiovascular Health Attitude Scale (CCHPAS),\u0026rdquo; and the \u0026ldquo;Nutrition\u0026ndash;Exercise Behaviour Scale (NEBS).\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocio-Demographic Data Collection Form\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA ten-item form collecting data on students\u0026rsquo; age, sex, and parental education levels.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eChildren\u0026rsquo;s Cardiovascular Health Promotion Attitude Scale (CCHPAS)\u003c/strong\u003e: Developed by Arvidson (\u003cspan class=\"CitationRef\"\u003e1990\u003c/span\u003e), this 16-item 4-point Likert-type scale measures attitudes in four domains: stress control, smoking, nutrition, and exercise. The Turkish validity and reliability study was conducted by Ozturk Haney (2002). Scores for each sub-dimension range from 4 to 16, and total scores range from 16 to 64, with higher scores indicating more positive attitudes toward heart health. The overall Cronbach\u0026rsquo;s alpha of the scale is 0.80, with sub-dimensions ranging between 0.76 and 0.63 (Ozturk Haney \u0026amp; Bahar, \u003cspan class=\"CitationRef\"\u003e2014\u003c/span\u003e). The Cronbach\u0026rsquo;s alpha values calculated in the current study are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNutrition Exercise Behaviour Scale (NEBS)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDeveloped by Yurt (\u003cspan class=\"CitationRef\"\u003e2008\u003c/span\u003e), this 5-point Likert scale consists of four sub-dimensions. The psychological eating behaviour subscale ranges from 11 to 55, with higher scores indicating a higher risk of psychological eating behaviour. The healthy and unhealthy nutrition-exercise behaviour subscales range from 14 to 70, where higher scores reflect stronger adherence to each respective behaviour. The meal pattern subscale ranges from 6 to 30, with higher scores suggesting better meal regularity. The overall Cronbach\u0026rsquo;s alpha is 0.85, with sub-dimensions ranging between 0.61 and 0.73. Reliability analysis results are also provided in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eReliability Analysis Results for the Measurement Instruments\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eScales\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCronbach\u0026rsquo;s Alpha\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eChildren\u0026rsquo;s Cardiovascular Health Promotion Attitude Scale\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExercise Subscale\u003c/p\u003e\n\u003cp\u003eNutrition Subscale\u003c/p\u003e\n\u003cp\u003eSmoking Subscale\u003c/p\u003e\n\u003cp\u003eStress Control Subscale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.73\u003c/p\u003e\n\u003cp\u003e0.72\u003c/p\u003e\n\u003cp\u003e0.61\u003c/p\u003e\n\u003cp\u003e0.67\u003c/p\u003e\n\u003cp\u003e0.65\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNutrition Exercise Behaviour Scale\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePsychological Eating Behaviour Subscale\u003c/p\u003e\n\u003cp\u003eHealthy Nutrition-Exercise Behaviour Subscale\u003c/p\u003e\n\u003cp\u003eUnhealthy Nutrition-Exercise Behaviour Subscale\u003c/p\u003e\n\u003cp\u003eMeal Pattern Subscale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.79\u003c/p\u003e\n\u003cp\u003e0.80\u003c/p\u003e\n\u003cp\u003e0.62\u003c/p\u003e\n\u003cp\u003e0.63\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n\u003ch2\u003eData Analysis\u003c/h2\u003e\n\u003cp\u003eThe collected data were analysed using SPSS (Statistical Package for the Social Sciences) for Windows, version 25.0. Descriptive statistical methods were employed, including frequency, percentage, minimum\u0026ndash;maximum values, mean, and standard deviation. Cronbach\u0026rsquo;s alpha coefficients were calculated to assess the reliability of the scales used in the study. To evaluate the normal distribution of continuous variables, skewness and kurtosis values were examined to ensure they fell within the \u0026plusmn;\u0026thinsp;3 range. Prior to testing normality, outlier analysis was conducted to remove extreme observations.\u003c/p\u003e\n\u003cp\u003eParametric tests were applied to variables with normal distribution. Pearson correlation analysis was used to investigate the relationships between continuous variables. Additionally, multiple linear regression analysis was conducted to determine the influence of independent variables on dependent variables.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic Characteristics of the Participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e11.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e197\u003c/p\u003e \u003cp\u003e183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.8\u003c/p\u003e \u003cp\u003e48.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGrade Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5th Grade\u003c/p\u003e \u003cp\u003e6th Grade\u003c/p\u003e \u003cp\u003e7th Grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e124\u003c/p\u003e \u003cp\u003e141\u003c/p\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.6\u003c/p\u003e \u003cp\u003e37.1\u003c/p\u003e \u003cp\u003e30.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMother\u0026rsquo;s Educational Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary School Graduate\u003c/p\u003e \u003cp\u003eSecondary School Graduate\u003c/p\u003e \u003cp\u003eHigh School Graduate\u003c/p\u003e \u003cp\u003eUniversity Graduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003cp\u003e65\u003c/p\u003e \u003cp\u003e137\u003c/p\u003e \u003cp\u003e136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.1\u003c/p\u003e \u003cp\u003e17.1\u003c/p\u003e \u003cp\u003e36.1\u003c/p\u003e \u003cp\u003e35.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMother\u0026rsquo;s Occupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomemaker\u003c/p\u003e \u003cp\u003eWorker\u003c/p\u003e \u003cp\u003eCivil Servant\u003c/p\u003e \u003cp\u003eSelf-Employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e229\u003c/p\u003e \u003cp\u003e30\u003c/p\u003e \u003cp\u003e92\u003c/p\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.3\u003c/p\u003e \u003cp\u003e7.9\u003c/p\u003e \u003cp\u003e24.2\u003c/p\u003e \u003cp\u003e7.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFather\u0026rsquo;s Educational Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary School Graduate\u003c/p\u003e \u003cp\u003eSecondary School Graduate\u003c/p\u003e \u003cp\u003eHigh School Graduate\u003c/p\u003e \u003cp\u003eUniversity Graduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003cp\u003e63\u003c/p\u003e \u003cp\u003e143\u003c/p\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003cp\u003e16.6\u003c/p\u003e \u003cp\u003e37.6\u003c/p\u003e \u003cp\u003e36.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFather\u0026rsquo;s Occupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCivil Servant\u003c/p\u003e \u003cp\u003eWorker\u003c/p\u003e \u003cp\u003eSelf-Employed\u003c/p\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e136\u003c/p\u003e \u003cp\u003e117\u003c/p\u003e \u003cp\u003e100\u003c/p\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.8\u003c/p\u003e \u003cp\u003e30.8\u003c/p\u003e \u003cp\u003e26.3\u003c/p\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily\u0026rsquo;s Economic Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncome less than Expenses\u003c/p\u003e \u003cp\u003eIncome equal to Expenses\u003c/p\u003e \u003cp\u003eIncome more than Expenses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003cp\u003e236\u003c/p\u003e \u003cp\u003e128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003cp\u003e62.1\u003c/p\u003e \u003cp\u003e33.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily Type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNuclear Family\u003c/p\u003e \u003cp\u003eExtended Family\u003c/p\u003e \u003cp\u003eSingle-Parent Family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e296\u003c/p\u003e \u003cp\u003e55\u003c/p\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77.9\u003c/p\u003e \u003cp\u003e14.5\u003c/p\u003e \u003cp\u003e7.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe average age of the participating students was 11.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93 years. Of these students, 51.8% were female. It was found that 35.8% of the mothers held a university degree, and 60.3% were homemakers. Regarding paternal education, 37.6% had completed high school, and 35.8% were civil servants. In terms of family structure, 62.1% reported income equal to expenses, and 77.9% lived in a nuclear family (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive Statistics for the Scales\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScale / Subscales\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMax\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCCHPAS Total Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExercise Subscale\u003c/p\u003e \u003cp\u003eNutrition Subscale\u003c/p\u003e \u003cp\u003eSmoking Subscale\u003c/p\u003e \u003cp\u003eStress Control Subscale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003cp\u003e4.00\u003c/p\u003e \u003cp\u003e4.00\u003c/p\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.00\u003c/p\u003e \u003cp\u003e14.00\u003c/p\u003e \u003cp\u003e10.00\u003c/p\u003e \u003cp\u003e13.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.86\u003c/p\u003e \u003cp\u003e7.98\u003c/p\u003e \u003cp\u003e5.40\u003c/p\u003e \u003cp\u003e6.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.98\u003c/p\u003e \u003cp\u003e2.23\u003c/p\u003e \u003cp\u003e1.79\u003c/p\u003e \u003cp\u003e2.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNEBS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychological Eating Behaviour Subscale\u003c/p\u003e \u003cp\u003eHealthy Nutrition-Exercise Behaviour Subscale\u003c/p\u003e \u003cp\u003eUnhealthy Nutrition-Exercise Behaviour Subscale\u003c/p\u003e \u003cp\u003eMeal Pattern Subscale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.00\u003c/p\u003e \u003cp\u003e23.00\u003c/p\u003e \u003cp\u003e18.00\u003c/p\u003e \u003cp\u003e9.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.00\u003c/p\u003e \u003cp\u003e70.00\u003c/p\u003e \u003cp\u003e59.00\u003c/p\u003e \u003cp\u003e30.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.32\u003c/p\u003e \u003cp\u003e47.78\u003c/p\u003e \u003cp\u003e38.15\u003c/p\u003e \u003cp\u003e21.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.14\u003c/p\u003e \u003cp\u003e10.14\u003c/p\u003e \u003cp\u003e7.64\u003c/p\u003e \u003cp\u003e4.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the minimum and maximum scores, mean, and standard deviation values for the scale scores.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelations Between the Scales\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eScale/Subscales\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eNEBS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychological Eating Behaviour\u003c/p\u003e \u003cp\u003er p\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHealthy Nutrition-Exercise Behaviour\u003c/p\u003e \u003cp\u003er p\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUnhealthy Nutrition-Exercise Behaviour\u003c/p\u003e \u003cp\u003er p\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMeal Pattern\u003c/p\u003e \u003cp\u003er p\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCCHPAS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.207\u003csup\u003e**\u003c/sup\u003e 0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e.566\u003csup\u003e**\u003c/sup\u003e 0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.105\u003csup\u003e*\u003c/sup\u003e 0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e.505\u003csup\u003e**\u003c/sup\u003e 0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.092 0.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e.518\u003csup\u003e**\u003c/sup\u003e 0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.041 0.430\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e.277\u003csup\u003e**\u003c/sup\u003e 0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNutrition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.202\u003csup\u003e**\u003c/sup\u003e 0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e.460\u003csup\u003e**\u003c/sup\u003e 0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.079 0.126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e.451\u003csup\u003e**\u003c/sup\u003e 0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.097 0.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e.164\u003csup\u003e**\u003c/sup\u003e 0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e.204\u003csup\u003e**\u003c/sup\u003e 0.320\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e.256\u003csup\u003e**\u003c/sup\u003e 0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStress Control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e.151\u003csup\u003e**\u003c/sup\u003e 0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e.347\u003csup\u003e**\u003c/sup\u003e 0.0001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.051 0.319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e.348\u003csup\u003e**\u003c/sup\u003e 0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003er: Pearson correlation coefficient ; *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; **p\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAn analysis of the relationships between scales revealed several statistically significant correlations. A weak, negative correlation was found between the CCHPAS scores and the NEBS psychological eating behaviour subscale (r = -0.207, p\u0026thinsp;=\u0026thinsp;0.000). A moderate, positive correlation was observed between CCHPAS scores and the healthy nutrition-exercise behaviour subscale (r\u0026thinsp;=\u0026thinsp;0.566, p\u0026thinsp;=\u0026thinsp;0.000). A weak, negative correlation emerged with the unhealthy nutrition-exercise behaviour subscale (r = -0.105, p\u0026thinsp;=\u0026thinsp;0.042), and a moderate, positive correlation with the meal pattern subscale (r\u0026thinsp;=\u0026thinsp;0.505, p\u0026thinsp;=\u0026thinsp;0.000).\u003c/p\u003e \u003cp\u003eThere was also a moderate, positive correlation between the exercise subdimension of CCHPAS and the healthy nutrition-exercise behaviour subscale of NEBS (r\u0026thinsp;=\u0026thinsp;0.518, p\u0026thinsp;=\u0026thinsp;0.000), along with a weak, positive correlation with the meal pattern subscale (r\u0026thinsp;=\u0026thinsp;0.277, p\u0026thinsp;=\u0026thinsp;0.000). A weak, negative correlation was detected between the nutrition subdimension of CCHPAS and the psychological eating behaviour subscale of NEBS (r = -0.202, p\u0026thinsp;=\u0026thinsp;0.000). In contrast, moderate, positive correlations were noted with the healthy nutrition-exercise behaviour (r\u0026thinsp;=\u0026thinsp;0.460, p\u0026thinsp;=\u0026thinsp;0.000) and meal pattern (r\u0026thinsp;=\u0026thinsp;0.451, p\u0026thinsp;=\u0026thinsp;0.000) subscales.\u003c/p\u003e \u003cp\u003eThe smoking subdimension of CCHPAS showed weak, positive correlations with both the healthy nutrition-exercise behaviour (r\u0026thinsp;=\u0026thinsp;0.164, p\u0026thinsp;=\u0026thinsp;0.002) and meal pattern (r\u0026thinsp;=\u0026thinsp;0.256, p\u0026thinsp;=\u0026thinsp;0.000) subscales. Similarly, the stress control subdimension was weakly and positively correlated with the psychological eating behaviour (r\u0026thinsp;=\u0026thinsp;0.151, p\u0026thinsp;=\u0026thinsp;0.003), healthy nutrition-exercise behaviour (r\u0026thinsp;=\u0026thinsp;0.347, p\u0026thinsp;=\u0026thinsp;0.000), and meal pattern (r\u0026thinsp;=\u0026thinsp;0.348, p\u0026thinsp;=\u0026thinsp;0.000) subscales (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultiple Linear Regression Analysis Explaining Children\u0026rsquo;s Cardiovascular Health Promotion Attitude Levels\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnstandardised\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVIF value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eF-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eModel p-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAdjusted R\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBeta\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStd. Error\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.630\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.593\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003e48.414\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003e0.429\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychological Eating Behaviour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.464\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealthy Nutrition-Exercise Behaviour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-8.881\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.414\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnhealthy Nutrition-Exercise Behaviour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.440\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeal Pattern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.329\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-5.871\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.426\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eGrade (Reference: 7th Grade)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5th Grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.932\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.553\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-3.494\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.512\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6th Grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.584\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.524\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-3.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.440\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA multiple linear regression analysis was conducted to identify the nutritional and exercise behaviours and personal characteristics that influenced children\u0026rsquo;s attitudes toward cardiovascular health promotion. Initially, variables with statistically significant differences in socio-demographic comparisons and significant correlations between NEBS subdimensions and CCHPAS scores were selected as independent variables for the regression model.\u003c/p\u003e \u003cp\u003eThe model was statistically significant overall (F\u0026thinsp;=\u0026thinsp;48.414, p\u0026thinsp;=\u0026thinsp;0.000). The independent variables collectively explained 42.9% of the variance in CCHPAS scores (Adjusted R\u0026sup2; = 0.429). According to the model, unhealthy nutrition-exercise behaviour and psychological eating behaviour had negative effects on attitude scores, whereas healthy nutrition-exercise behaviour and regular meal patterns had positive effects. Furthermore, the attitude scores of fifth-grade students were significantly lower than those of seventh-grade students (β = -1.932), as were the scores of sixth-grade students (β = -1.584) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eChanges in individual lifestyle habits form the first step in reducing the population-wide risk of cardiovascular diseases. Although implementing such changes may be challenging, they remain among the most cost-effective and side-effect-free preventive strategies (Aydın, Oflu \u0026amp; Yal\u0026ccedil;ın, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). When considering lifestyle changes, dietary and exercise behaviours are typically the most prominent components (Chang et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). A study demonstrated that many modifiable risk factors for cardiovascular diseases stem from unhealthy habits and attitudes acquired during childhood and that up to 80% of these diseases can be prevented by promoting healthy eating and exercise habits (Carter et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCardiovascular health-promoting attitudes acquired in childhood are highly effective in reducing risk factors that may emerge during adulthood (Rouzbahani et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). In our study, the relationship between secondary school students\u0026rsquo; cardiovascular health attitudes and their nutrition-exercise behaviours was assessed using the CCHPAS and NEBS, and statistically significant results were observed across various subdimensions.\u003c/p\u003e \u003cp\u003eWhen the scores of the NEBS subdimensions (healthy nutrition-exercise behaviour, unhealthy nutrition-exercise behaviour, and meal pattern) in this study are compared with those reported in the literature, similar mean scores were noted in studies conducted by Akan (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), Yurt and Yıldız (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), and Ayaz Alkaya and Kulak\u0026ccedil;ı Altıntaş (2021). However, the psychological (dependent) eating behaviour subscale scores among adolescents in our study were lower. This finding indicates that adolescents in this study exhibited lower levels of psychological eating behaviour and more positive eating patterns. Furthermore, as scores for psychological eating behaviour decreased, attitudes toward promoting heart health improved. These results suggest that children\u0026rsquo;s attitudes toward heart health and nutrition-exercise behaviours vary across subdimensions and highlight the potential for improvement in meal regularity. These findings hold significant importance considering the long-term impact of lifestyle habits on children\u0026rsquo;s health.\u003c/p\u003e \u003cp\u003eCCHPAS total scores were negatively influenced by unhealthy nutrition-exercise and psychological eating behaviour, whereas healthy nutrition-exercise and meal pattern scores had a positive impact. Akan (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) found that adolescents who engaged in regular exercise had higher average scores for healthy and unhealthy nutrition-exercise behaviours than those who did not exercise. However, adolescents who did not exercise regularly showed higher scores in the meal pattern subdimension. Bebiş et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) also reported that adolescents who engaged in sports exhibited more positive nutrition and exercise behaviours than those who did not. Enhancing physical activity requires a holistic, multisectoral, and culturally informed approach at both individual and societal levels (Ministry of Health, 2014). As obesity continues to escalate into a major public health concern globally and nationally, international organisations like the WHO, along with many national bodies, have implemented a range of strategies, such as promoting balanced nutrition and active lifestyles through various programmes and action plans (Altıncı et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study also revealed that fifth- and sixth-grade students had lower attitude scores compared to seventh-grade students. This aligns with similar findings in the literature (Ayaz Alkaya \u0026amp; Kulak\u0026ccedil;ı Altıntaş, 2021; Montelpare et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). In Akan\u0026rsquo;s (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) study, 11-year-old adolescents had significantly higher scores in the healthy nutrition-exercise subdimension than those in other age groups, while 12-year-olds had higher scores than 14-year-olds. T\u0026uuml;mer et al. (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) found that as age increased among middle school students, healthy nutrition and exercise behaviours declined. Demirezen and Coşansu (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2005\u003c/span\u003e) observed that the level of nutritional risk increased with age in adolescents. Aksoydan and \u0026Ccedil;akır (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2011\u003c/span\u003e) reported that students\u0026rsquo; frequency of eating at the school canteen decreased, and fast food consumption increased with educational level.\u003c/p\u003e \u003cp\u003eA study examining adolescents\u0026rsquo; eating habits, physical activity levels, and body mass index across different education stages revealed a decrease in regular meal consumption, an increase in meal skipping, fast food consumption, and eating outside the school canteen. Breakfast was the most frequently skipped meal, and girls were found to skip meals and eat at school canteens more often than boys. The number of overweight students also increased with educational level (Akın \u0026amp; Sani Bozkurt, 2020; Aksoydan \u0026amp; \u0026Ccedil;akır, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). These changes in dietary habits may be linked to shifts in social settings, lifestyle, and environmental factors. As adolescents grow older, they tend to spend more time with peers outside the home, eat out more frequently, and have easier access to snacks, which may explain these adverse changes in dietary habits.\u003c/p\u003e \u003cp\u003eHealth behaviours learned during childhood are more likely to become integrated into personal lifestyles and are more enduring compared to those acquired in adulthood. School-aged children are expected to take responsibility for and manage health behaviours such as nutrition and physical activity (Eo \u0026amp; Kim, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Ayaz Alkaya and Kulak\u0026ccedil;ı Altıntaş (2021) found that adolescents displayed moderate levels of healthy nutrition and exercise behaviours. Similar findings were reported by Hendek\u0026ccedil;i and Aydın Avcı (2020) and Kalay and Sonay T\u0026uuml;rkmen (2015). Poor dietary habits and insufficient physical activity are major contributors to the development of chronic diseases such as cardiovascular disease, diabetes, and cancer. Regular physical activity provides long-term health benefits for children and adolescents by improving cardiovascular fitness, enhancing bone mass, and promoting mental well-being (Pender, 2015). Therefore, adopting healthy lifestyle behaviours, including balanced nutrition and regular exercise, from an early age is essential for protecting and improving adolescent health. Nutrition and physical activity programmes are effective tools in fostering these habits among children and adolescents.\u003c/p\u003e\n\u003ch3\u003eImplication for practice\u003c/h3\u003e\n\u003cp\u003eThe results of this study suggest several actionable strategies for pediatric nurses and healthcare professionals working with adolescents. Given the complex relationship between heart health attitudes and nutrition-exercise behaviours, pediatric nurses play a vital role in both education and advocacy to support healthy lifestyle development. Specifically:\u003c/p\u003e \u003cp\u003eEarly and consistent health education is critical. Pediatric nurses can advocate for and participate in implementing nutrition and physical activity education beginning in early childhood and continuing throughout the school years. Parental and community involvement is essential. Pediatric nurses should encourage family-centered approaches and contribute to school-based nutrition education programs that actively involve caregivers. Nurses should be involved in ongoing professional development related to adolescent nutrition and health promotion to ensure up-to-date, evidence-based guidance is provided. Further research with larger, diverse populations is needed to tailor interventions to regional and cultural needs, and pediatric nurses can contribute to and lead these efforts. By integrating these strategies into pediatric nursing practice, professionals can help transform positive health attitudes into sustainable, heart-healthy behaviours among adolescents.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe relationship between attitudes toward heart health and nutrition-exercise behaviours is complex. While possessing positive health attitudes can facilitate the adoption of healthy behaviours, individual and environmental factors may influence this process. Programmes designed to promote cardiovascular health should not only enhance individuals\u0026rsquo; attitudes but also support the transformation of these attitudes into sustainable behaviours. Thus, strengthening attitudes related to heart health and fostering supportive social environments play a vital role in the widespread adoption of healthy lifestyles.\u003c/p\u003e \u003cp\u003eRegular and balanced dietary habits, along with consistent physical activity, are among the most important factors for maintaining and improving health. The formation of healthy lifestyle habits during adolescence can be achieved through nutrition education that begins in childhood and continues throughout formal education. Incorporating basic nutrition education into curricula at all levels of schooling, utilising engaging methods such as stories, films, and short plays, and providing in-service training to teachers about the latest developments in nutrition can help sustain these educational efforts. Establishing school-based nutrition education centres to educate families and maintaining continuous cooperation among teachers, students, and parents will contribute significantly to the effectiveness and long-term success of these interventions.\u003c/p\u003e \u003cp\u003eGiven the findings of this study, it is recommended that future research with larger sample sizes be conducted in different regions to explore the relationship between adolescents\u0026rsquo; nutrition-exercise behaviours, body mass index, and the influencing factors in greater depth. This would help further clarify regional differences and support the development of more targeted and effective interventions.\u003c/p\u003e "},{"header":"Declarations","content":"\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003eBefore the study commenced, written approval was obtained from Zonguldak Bulent Ecevit University Ethics Committee for Human Research (first decision dated 27.3.2023, number 289688 and then the ethics committee decision was renewed with the date and number 04.07.2025/620925) and from the institutions where the research was conducted. Before participation, the students received written information stating that their data would be used for scientific purposes and their identities would be kept confidential. The study adhered to the principles of the Declaration of Helsinki.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eData availability\u003c/h2\u003e \u003cp\u003eThe data can be shared upon request from the authors.\u003c/p\u003e \u003c/div\u003e\u003cp\u003e \u003ch2\u003eDeclaration of competing interest\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eTKA: Writing\u0026ndash;review \u0026amp; editing, Writing original draft, Visualization, Validation, Supervision, Project administration, Methodology, Investigation, Formal analysis. IBA: Writing\u0026ndash;review \u0026amp; editing, Writing\u0026ndash;original draft, Visualization, Supervision, Investigation, Conceptualization. MB: Project administration, Formal analysis, Conceptualization, Data curation.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThis study was funded by the Scientific and Technological Research Council (T\u0026Uuml;BİTAK) under the 2209-A Program for Supporting Research Projects of Undergraduate Students, so we thank to TUBİTAK for supporting the Project and all the participants.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAkan M (2018) Ad\u0026ouml;lesanlarda beslenme egzersiz davranışları ile beden kitle indeksi arasındaki ilişki. 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Am J Health Behav 47(2):408\u0026ndash;419. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5993/AJHB.47.2.20\u003c/span\u003e\u003cspan address=\"10.5993/AJHB.47.2.20\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cardiovascular health, nutrition-exercise behavior, secondary school students","lastPublishedDoi":"10.21203/rs.3.rs-8248194/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8248194/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground and Aims:\u003c/h2\u003e \u003cp\u003eAccording to World Health Organization statistics, Cardiovascular Diseases (CVD) is the leading cause of death in the world and accounts for 30% of all deaths. In Turkey, this rate is 47%. Health-related attitudes and behaviors that are effective in the formation of CVDs that show symptoms in adulthood begin to develop in childhood. This research was conducted to evaluate the relationship between secondary school students' heart health promotion attitudes and nutrition-exercise behaviors.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe research was conducted as a descriptive-cross-sectional and correlation-seeking type study. Research data were collected using the \u0026ldquo;Sociodemographic Data Collection Form, \u0026ldquo;Children\u0026rsquo;s Cardiovascular Health Promotion Attitude Scale\u0026rdquo;and \u0026ldquo;Nutrition-Exercise Behavior Scale\u0026rdquo;. Within the scope of the research, 395 data were collected, Descriptive statistical methods (number, percentage, min-max values, mean, standard deviation) were used when evaluating the data.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e51.8% of the students are girls, 35.3% are 12 years old, and 26.1% are 13 years old. Children's Cardiovascular Health Promotion Attitude Scale mean score was 27.13\u0026thinsp;\u0026plusmn;\u0026thinsp;5.44; 6.86\u0026thinsp;\u0026plusmn;\u0026thinsp;1.98 for Exercise Dimension; 7.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.23 for Nutrition Dimension; It was calculated as 5.40\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79 for the Cigarette Dimension and 6.88\u0026thinsp;\u0026plusmn;\u0026thinsp;2.10 for the Stress Control Dimension. Nutrition-Exercise Behavior Scale mean scores were 30.32\u0026thinsp;\u0026plusmn;\u0026thinsp;9.14 for the Psychologically Dependent Eating Behavior subscale; 47.78\u0026thinsp;\u0026plusmn;\u0026thinsp;10.14 for the Healthy Nutrition Exercise Behavior sub-dimension; 38.15\u0026thinsp;\u0026plusmn;\u0026thinsp;7.64 for the Unhealthy Nutrition Exercise Behavior subscale; For the Meal Pattern sub-dimension, it was calculated as 21.35\u0026thinsp;\u0026plusmn;\u0026thinsp;4.50.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eWhile unhealthy nutrition, exercise behavior and psychologically dependent eating behavior positively affect attitude scores; healthy eating behavior and meal patterns negatively affect the scores.\u003c/p\u003e","manuscriptTitle":"Nutrition-Exercise Behaviours and Heart Health: A Study on Secondary School Students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-20 12:08:15","doi":"10.21203/rs.3.rs-8248194/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cd14ec7d-e868-4894-a646-956e0e87ae34","owner":[],"postedDate":"February 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":63195034,"name":"Health sciences/Cardiology"},{"id":63195035,"name":"Health sciences/Diseases"},{"id":63195036,"name":"Health sciences/Health care"},{"id":63195037,"name":"Health sciences/Medical research"},{"id":63195038,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-05-13T13:57:02+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-20 12:08:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8248194","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8248194","identity":"rs-8248194","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}