International Journal of Environmental Research and Public Health Review Parenting and Healthy Teenage Lifestyles Paloma Alonso-Stuyck Institute for Higher Family Studies, International University of Catalonia, 08017 Barcelona, Spain; palonsos@uic.es; Tel.: +34-676-686-641  Received: 29 May 2020; Accepted: 24 July 2020; Published: 28 July 2020  Abstract: How can one promote adolescent adjustment toward a healthy lifestyle? The first step is to locate the healthy habit configuration within the family environment. The hypothesis is that, if adolescent lifestyles are assumed autonomously during adolescence, then it is very likely that they will last throughout life. How does this relate to parenting styles? After reviewing the literature of the last four decades on adolescent behavioral autonomy and scientific articles that link healthy lifestyles with parenting, several conclusions have been reached, such as the relevance of recovering the biopsychosocial richness of healthy lifestyles, the need to use a dialogue strategy to resolve discrepancies between adolescents and their parents, and the adequacy of the personalistic parenting style to promote adjusted adolescent behavioral autonomy, and with it maintain healthy lifestyles in the long term. Keywords: healthy lifestyles; parenting; adolescence behavioral autonomy; discrepancy between parents and teenage children 1. Introduction The main objective of this article was to pinpoint which parenting styles promote adolescent adjustment according to recent research: What has been investigated so far and what aspects remain unknown? Why do certain healthy adolescent lifestyles not continue into adulthood? What changes occur if the way of dealing with discrepancies between parents and children regarding adolescent autonomy is modified? Before reviewing these variables throughout the last four decades and in order to interpret the results in greater depth, the following three constructs are presented: healthy lifestyles, parenting styles, and adolescent autonomy. 1.1. Healthy Lifestyles This section exposes the need to restore the concept of healthy lifestyles that integrate the three personal dimensions: affective, conative, and cognitive, given that personal adjustment lies within the balance of those three domains. It is proposed that if childhood is understood as the period in which the affective relational style is configured, then it is during adolescence that the behavioral aspects of lifestyles are consolidated; and these lifestyles will continue into adulthood as long as they have been assumed autonomously. To speak of healthy lifestyles, in their entirety, is to speak of personal adjustment. Most of the research on healthy lifestyles focuses on biorhythms—the physical dimensions of healthy habits—due to their connection with chronic diseases [1]. However, since 1948, the World Health Organization (WHO) has promoted a concept of health that also integrates psychological and social aspects, typical of the prevailing biopsychosocial paradigm in humanities and social sciences. In line with this concept of integration, it is specifically the three personal dimensions previously mentioned that are used most extensively in adolescent healthy lifestyle questionnaires [2–4] to evaluate personal adjustment. Int. J. Environ. Res. Public Health 2020, 17, 5428; doi:10.3390/ijerph17155428 www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Health 2020, 17, 5428 2 of 15 Int. J. Environ. Res. Public Health 2020, 17, x 2 of 15 In Figure 1, In Figure 1,the thehealthy healthylifestyle lifestylebehaviors behaviors and and their their connection connection to the to the personal personal dimensions dimensions and and their motivations or basic tendencies are represented. The first category reflects the somaticsomatic their motivations or basic tendencies are represented. The first category reflects the habits: habits: sleep,and sleep, food foodhydration, and hydration,hygienehygiene and andskin skin care,care, andand physical physical activity.These activity. Thesehabits habits cancan be be incorporated into the basic activities of daily living (ADL) [5]. The second category incorporated into the basic activities of daily living (ADL) [5]. The second category illustrates illustrates proactivity, aproactivity, psychological attitude of initiative a psychological attitudeandofresponsibility initiative and toward one’s own toward responsibility physical,one’s emotional, financial, own physical, and environmental emotional, financial,and anddomestic health.and environmental In domestic children and teenagers health. this attitude In children is associated and teenagers with this attitude wealth is associated with wealth and public safety [6]. The third category can be summarized as balance,one and public safety [6]. The third category can be summarized as balance, the way in which the distributes way in which one’s own one time between distributes one’swork, own timefamily, and leisure. between work,Afamily, properand balance between leisure. the personal, A proper balance work, between andthe social sphereswork, personal, translates and into social adequate spherestime management, translates which may into adequate timehelp prevent addiction management, which problems. Meeting friends over the weekend for a few drinks is may help prevent addiction problems. Meeting friends over the weekend for a few drinksnot the same as drinking alcohol every is not the day, sameinasthe same way drinking that every alcohol spendingday,half an same in the hour away daythat doing sports is spending notanthe half same hour as 4doing a day hourssports every day, is notetc. theThus, sametheas proportion 4 hours every of time day,devoted etc. Thus,to athe specific activityofcan proportion timereflect eithertoaaprevention devoted factor specific activity or a risk factor in terms of addictions [7–9]. can reflect either a prevention factor or a risk factor in terms of addictions [7–9]. Figure 1. Biopsychosocial, personal, and motivational classification of healthy lifestyles. Figure 1 integrates the classical classification of the personal dimensions (affection, intelligence, and will) withwith basic basic human human tendencies tendencies (conservation, (conservation, verification, verification, andand improvement). improvement). The balance between between these these dimensions dimensions promotes personal promotes adjustment personal and integrates adjustment and all areas of the integrates allbiopsychosocial areas of the paradigm. From the psychological point of view, the individual biopsychosocial paradigm. From the psychological point of view, the individual balance balance is rooted in theisharmonic rooted in combination the harmonicof the affective, combination ofcognitive, the affective,andcognitive, conative dimensions, and conativewhich are reciprocally dimensions, which arerooted in the reciprocally sensitivity, rooted in the intelligence, sensitivity,and will that are intelligence, andreflected will thatinare thereflected traits ofin self-transcendence: beauty, truth, the traits of self-transcendence: good, beauty, and coexistence truth, good, and [10]. coexistence [10]. Therefore, when investigating healthy lifestyles, it becomes imperative to analyze cognitive and affective affectiveaspects aspectsand andobservable observable behaviors behaviors which can be which collected can throughthrough be collected measurable data. To illustrate measurable data. To why this is illustrate whynecessary, we can usewe this is necessary, thecan following example: one use the following cannotone example: assume cannot that a teenager assume that awho does teenager not whoconsume does notalcoholconsumeenjoys goodenjoys alcohol psychosocial adjustment ifadjustment good psychosocial that behavior doesbehavior if that not correspond to does not an autonomous decision, or if the behavior is forced. This implies that, in addition correspond to an autonomous decision, or if the behavior is forced. This implies that, in addition to to the observable result, it is convenient the observable result, itto is analyze convenient why toaanalyze person why acts in a specific a person actsway, what knowledge in a specific way, whatthe action is knowledge based on, and the action how the is based on, person and how feels theabout person that particular feels behavior. about that Thisbehavior. particular would beThis the proper wouldway to be the promote proper way lifestyles that last to promote throughout lifestyles lifethroughout that last because of their free nature. life because of their free nature. It is precisely this balance between personal dimensions that is required to verify whether or not an act is truly truly human, human, free, free, because because it it implies implies consent consent andand caveat caveat [11]. [11]. In other words, the person understands understands the theimplications implicationsofof what he/she what decides he/she to dotoand decides do chooses to do it. and chooses to Only do it.from Onlythis internal from this governance that combines internal governance all three personal that combines all three dimensions does a person personal dimensions doesact freely and a person have the act freely andability have to thelove. ability to love. Figure 2 represents a truly free human act using the metaphor of the iceberg, with the wavy line representing the sea level. In this this way, way, one can find that below the observable act dependent on on will, will, intelligence and feelings are present: the teenager’s thoughts and feelings in regard to the act. In other Int. J. Environ. Res. Public Health 2020, 17, 5428 3 of 15 Int. J. Environ. Res. Public Health 2020, 17, x 3 of 15 intelligence and feelings are present: the teenager’s thoughts and feelings in regard to the act. In other words, words, the thebehavior’s behavior’semotional emotionaldimension dimensionhas a somatic has a somatic root—biological, root—biological, sensitive, or sensory—that sensitive, or sensory— makes sensesense that makes withwith the intervention of intelligence the intervention [12]. [12]. of intelligence When When aa type type of of behavior behavior isis repeated, repeated, it it becomes becomes aa stable stable trend, trend, aa lifestyle. lifestyle. These These trends trends help help us us achieve the best versions of ourselves when we can balance what we feel, think, achieve the best versions of ourselves when we can balance what we feel, think, and want. Thisand want. This balance is knownisclassically balance as virtue.asInvirtue. known classically this way, their In this contributions way, are endorsed their contributions by evolutionary are endorsed theories: by evolutionary atheories: person’sa developmental stage—sensorimotor, operational, and formal—of person’s developmental stage—sensorimotor, operational, and formal—of Piagetian Piagetian theory is balanced theory is by the Aristotelian balanced virtues—temperance, by the Aristotelian strength, justice, virtues—temperance, and prudence. strength, justice, andWhen adolescence prudence. When is reached, a period begins in which the necessary developmental milestones have adolescence is reached, a period begins in which the necessary developmental milestones have been been achieved so that healthy lifestyles can be established, as shown in Figure 2. achieved so that healthy lifestyles can be established, as shown in Figure 2. Figure 2. Figure 2. Dimensional Dimensional analogy analogybetween betweenhealth, health,personality, personality,Aristotelian Aristotelian virtues, virtues, and and Characteristics Characteristics of of free human action. free human action. Figure 2 illustrates illustrates the parallelism parallelism between the development development of Aristotelian Aristotelian virtues, the health dimensions, dimensions, and andthe thepersonal personal dimensions. dimensions. In fact, one might In fact, observeobserve one might that positive that psychology develops positive psychology develops the classical thecardinal classicalvirtues. cardinal virtues. Fromthis From this comparative comparative analysisanalysis between between personalpersonal dimensions, dimensions, Aristotelian Aristotelian virtues, virtues, and and biopsychosocial biopsychosocial evolutionary evolutionary theories, theories, one can infer one can infer the importance the importance of promoting a concept of promoting a conceptthat of healthy lifestyles of healthy goes lifestyles beyond basicthat goes beyond biorhythms—a basicthat model biorhythms—a embraces themodel WHO’sthat embraces proposal the WHO’stoproposal for individuals assume for leading the individuals role into their assume theinleading health role in their health all its biopsychosocial in allInits integrity. biopsychosocial addition integrity. to the biological prismIn addition of healthytolifestyles, the biological prism of the specific healthy lifestyles, psychosocial aspects the ofspecific psychosocial proactivity, aspects of that is, initiative andproactivity, purpose, that be can is, found. initiative andattitude This purpose, can be favors found. Thisgood establishing attitude favors establishing intrapersonal good intrapersonal and interpersonal relationships:and interpersonal with oneself and relationships: with others.with It is oneself and with a disposition that others. It is aboth is exercised disposition that issphere—domestic, in the private exercised both in the private sphere—domestic, financial—and the community financial—and sphere—environmental.the community sphere—environmental. It configures the relational DNA, It configures a personal the relational healthy DNA, style, and a personal healthy a sustainable style, and a sustainable social style. social style. Neuroscienceprovides Neuroscience providesa definitive a definitive guideline guideline to establishing to establishing long long term healthy term healthy lifestyleslifestyles by by stating stating that when thatsocial whenpleasure social pleasure guides education guides education and work, andthework, personthe interprets person interprets it as the ithighest as the form highestof form of [13]. learning learning [13]. In this In this sense, theresense, there is aamong is a consensus consensus among psychological psychological schools on theschoolsimportance on theof importance early of early experiences onexperiences on the child’s the child’s personality andpersonality therefore of and therefore the influence of of thethe influence of the family family environment environment in shaping this inaspect shaping this aspect of healthy of healthy lifestyles [14]. lifestyles [14]. psychology Personalistic Personalisticsupports psychology this supports statementthis by statementthat stressing by stressing the person that the person builds and grows builds and grows dialogue in affectionate in affectionate dialogue [15]. For [15].anFor children, children, affectionate an affectionate family environment familyprovides environment a feelingprovides a feeling of safety whichofallows safety them whichtoallows develop themthetobest develop the personal best personal versions versions of themselves. of themselves. In childhood, during the Piagetian sensorimotor period, the relational style of the individual is shaped by the type of attachment that is established during during this this period. period. This is known as attachment whichcan style which canbebe summarized summarized as aasmental a mental outline outline of whatof what interpersonal interpersonal relationships relationships are. This are. This mental mental is outline outline is configured configured during childhood during childhood and remainsand remains unconscious unconscious throughout throughout the rest of the restlife. one’s of one’s It is life. based not It is notonbased logicalondecisions logical decisions or reasoningor reasoning but is anbut is an unconscious unconscious behavioral behavioral imprint.imprint. The wayThe in way inawhich which a childitlearns child learns it is emotional is emotional and is by and is driven driven by following following and imitating and imitating significant significant people in people their in their environment. In a similar way, this study’s approach is that in adolescence, the beginning of the formal thinking stage, the teenager’s lifestyle is configured and maintained if it is taken on Int. J. Environ. Res. Public Health 2020, 17, 5428 4 of 15 environment. In a similar way, this study’s approach is that in adolescence, the beginning of the formal Int. J. Environ. Res. Public Health 2020, 17, x 4 of 15 thinking stage, the teenager’s lifestyle is configured and maintained if it is taken on autonomously [16]. It is therefore convenient autonomously to analyzeconvenient [16]. It is therefore the impacts to of parenting analyze the styles impactsonof theparenting acquisition of healthy styles on the lifestyles in adolescence. acquisition of healthy lifestyles in adolescence. 1.2. Parenting 1.2. Parenting This Thissecond secondsection section includes includesthe the evolution of parenting, evolution considering of parenting, that healthy considering thatlifestyles—adolescent healthy lifestyles— adjustment—are consolidated within the family environment. adolescent adjustment—are consolidated within the family environment. The importance The importance of promoting of adolescent autonomy emphasizing the three personal dimensions—affective, promoting adolescent autonomy emphasizing the three personal dimensions—affective, conative, conative, and cognitive—is and cognitive—is underlined. underlined. There are numerousreviews There are numerous reviews[17–21] [17–21]onon thethe origins origins and and evolution evolution of parental of parental educational educational styles. styles. Figure 3a shows the simplest approach [22] that only addresses Figure 3a shows the simplest approach [22] that only addresses the type of control—conative the type of control—conative dimension—while dimension—whileother othermodels models addadd the emotional the emotionaldimension: responsiveness dimension: [23] Figure responsiveness [23]3bFigure Currently, 3b the Currently, the concept of parenting has become more complex and can be understood as feelings, concept of parenting has become more complex and can be understood as a set of beliefs, a set of and patterns beliefs, of parental feelings, behavior and patterns that affect of parental the psychosocial behavior that affectfunctioning of children the psychosocial [24]. Even functioning though of children the authoritative style (high acceptance/implication and high coercion/imposition) [24]. Even though the authoritative style (high acceptance/implication and high coercion/imposition) was associated with adolescent adjustment was associated at the beginning, with adolescent adjustmentnuances at theofbeginning, this primacy soon emerged, nuances according of this primacy soonto emerged, the social context—horizontal vs. vertical, or individualistic vs. collectivist culture [25]. Currently, according to the social context—horizontal vs. vertical, or individualistic vs. collectivist culture [25]. perhaps at the behest of globalization derived from the digital world, we have very novel Currently, perhaps at the behest of globalization derived from the digital world, we have very novelresults that indicate that the indulgent results style (high that indicate thatacceptance/involvement) the indulgent style (highachieves a similar or greaterachieves acceptance/involvement) adjustment than the a similar or authoritative style in different adolescent adjustment variables [26]. That was greater adjustment than the authoritative style in different adolescent adjustment variables [26]. Thatinitially researched in Spain and Brazil was initially [27,28], in researched and lately Spain andit has been Brazil confirmed [27,28], in other and lately countries it has such as Germany been confirmed and the in other countries United such asStates Germany [29–31], and highlighting the United Statesthe importance of parental the [29–31], highlighting involvement importance in of variables parentalsuch as school involvement adjustment or being a victim of cyberbullying [32–34]. in variables such as school adjustment or being a victim of cyberbullying [32–34]. Figure Figure 3. Evolution 3. Evolution of theofparenting the parenting educational educational style concept style concept (a): one-dimensional; (a): one-dimensional; (b): two- (b): two-dimensional. dimensional. Other studies speak of how to banish toxic family scenarios with compassion-centered parenting Other studies intervention programsspeak of which [21], how toaddbanish toxic family scenarios with compassion-centered the cognitive—reflective—dimension of personality, inparenting addition intervention to the conativeprograms [21],ones and affective which add the cognitive—reflective—dimension contemplated in previous models. This is also the of approach personality, in of the addition tomodel personalist the conative [35], which and affectivea gradualness introduces ones contemplated in previous in the exercise models. of the three This is also the dimensions—conative, approach and affective, of the personalist model cognitive—as a way [35], whichthe to match introduces differentasociocultural gradualness scenarios in the exercise of thestages. and vital three dimensions—conative, Along affective, and with control and emotional cognitive—as a way to communication openness—responsiveness—a match the different sociocultural style is considered scenarios that appealsandto vital stages. Along with intelligence—cognitive control andpromote dimension—to emotional openness—responsiveness—a adolescent autonomy and make communication the style internalization of is considered healthy thatin lifestyles appeals to term the long intelligence—cognitive possible, in line withdimension—to promote the biopsychosocial, adolescent autonomy evolutionary, and make and contextual the internalization approach [36], as shown ofin healthy Figurelifestyles 4. in the long term possible, in line with the biopsychosocial, evolutionary, and contextual approach [36], as shown in Figure 4. Int. J. Environ. Res. Public Health 2020, 17, 5428 5 of 15 Int. J. Environ. Res. Public Health 2020, 17, x 5 of 15 Figure 4. Personalistic parenting model [35]. This parenting This parenting style style is is an an introduction introduction toto the the systemic systemic approach, approach, in in which which parenting parenting styles are styles are shaped by the contributions of parents shaped by the contributions of parents and and children children alike, something that can be verified by the alike, something that can be verified by the joint joint construction and construction andfamily familyfunctioning functioning models models[19,37–41]. Through [19,37–41]. Througha proper human a proper relationship—which human relationship— integrates which all the personal integrates dimensions—the all the personal personalpersonal dimensions—the adjustment of both parents adjustment of both and children parents matures. and children When analyzing matures. When family analyzinginteractions, psychoanalysis family interactions, interprets behavioral psychoanalysis interpretsproblems as aproblems behavioral failed process as a of individuation failed process of of adolescents from individuation their parents of adolescents [42]. from Therefore, their parentsit[42]. is interesting Therefore,toitunderstand what is interesting to parenting understand styles what contribute parenting to styles a healthy teenageto contribute autonomy a healthythat is ableautonomy teenage to sustain these that ishealthy able tolifestyles sustain previously acquired these healthy in the lifestyles family in previously the longinterm. acquired the family in the long term. 1.3. Adolescence 1.3. Adolescence Autonomy Autonomy This third This thirdsection section highlights highlightsthe the typetype of autonomy of autonomythat contributes to adolescent that contributes adjustment—autonomy to adolescent adjustment— that originates from the way in which parents and teenagers autonomy that originates from the way in which parents and teenagers deal deal with the typical discrepancies of this with the typical period, which of discrepancies involves the three this period, whichpersonal involvesdimensions. the three personal dimensions. Given the social nature of the human Given the social nature of the human being, being, healthy healthy autonomy autonomy is placed is placed in aninintermediate an intermediate state state between independence and dependence, interdependence. between independence and dependence, interdependence. It is a way of being and It is a way of being and acting acting that that permeates the whole person: the emotional, cognitive, and behavioral dimensions. permeates the whole person: the emotional, cognitive, and behavioral dimensions. Adolescents’ own Adolescents’ own evolutionary task evolutionary task[43], [43],discovering discovering and constructing and constructing theirtheir ownownidentity, drivesdrives identity, them to demand them greater to demand autonomy: they do not greater autonomy: theywant do notto continue want todoing whatdoing continue their parents what theirsay parents but rathersaytobut startrather makingto their start own decisions. This tends to generate discrepancies between parents and making their own decisions. This tends to generate discrepancies between parents and teenage teenage children regarding the expectations children regarding to who as the is responsible expectations forwho as to deciding what. The is responsible forway to deal deciding with what. Thethese waydiscrepancies to deal with is closely related to the internalization of the decisions made [17,44]. If parents these discrepancies is closely related to the internalization of the decisions made [17,44]. If parents do not promote do their children’s autonomy, children do not own their decisions and not promote their children’s autonomy, children do not own their decisions and cannot take cannot take them on. On the them contrary, on. On the if parenting contrary, styles supportstyles if parenting this evolutionary support thistask, each of thetask, evolutionary dimensions each ofoftheautonomy dimensionsgrows of asynchronously, contributing to a healthy identity [45,46], as shown in Figure autonomy grows asynchronously, contributing to a healthy identity [45,46], as shown in Figure 5. 5. Figure 5. Contributions Contributions of of the the autonomy autonomy dimensions dimensions for healthy adolescent identity. The type of confrontation has a big impact on healthy lifestyles in the short and long term. Therefore, it seems interesting to understand the beneficial impact of this asynchronous development Int. J. Environ. Res. Public Health 2020, 17, 5428 6 of 15 The type Int. J. Environ. Res. of confrontation Public Health 2020, 17,has x a big impact on healthy lifestyles in the short and long6 term. of 15 Therefore, it seems interesting to understand the beneficial impact of this asynchronous development of the different facets of autonomy autonomy and and respect respect it [47,48]. It is also also useful useful to to understand understand how how parenting parenting styles contribute to the optimal resolution of the discrepancy discrepancy between between parents parents and and adolescents. adolescents. How to Deal with the Discrepancy between Parents Parents and and Children Children The existence of the discrepancy between parents and adolescents regarding the expectations of decision-making isisconfirmed decision-making confirmedininthe thepsychological psychologicalevolutionary evolutionaryliterature [49–51]. literature Despite [49–51]. the fact Despite the that fact it diminishes that when it diminishes the cultural when gapgap the cultural between the the between twotwo decreases [52], decreases it isitcommon [52], forfor is common thethe amount amount of discretion of expected discretion by by expected adolescents to be adolescents to greater than be greater thatthat than estimated estimatedby their parents, by their as shown parents, as shownby the by delay the phenomenon delay phenomenonin Figure 6. 6. in Figure Figure Figure 6. Delay Delay phenomenon phenomenon of of parental parental expectations expectations regarding regarding adolescent autonomy. The way in which possible discrepancies between adolescents and their parents are dealt with seems to be decisive for adolescents making their own decisions. It is is not not so so much much about about whowho isis right, right, not even and not evenabout aboutwhat whatbehaviors behaviors areare included included in in thethe decision decision areas: areas: moral, moral, socio-conventional, socio-conventional, and and private private [17,53]; [17,53]; but but rather rather thethe way way in in which which these these discrepanciesare discrepancies aresolved. solved.These Thesecoping coping strategies strategies have been beenclassified, classified,leaving leaving thethe frequency frequencyas follows: 20% negotiation, as follows: 30% submission 20% negotiation, of the children 30% submission of the to the opinion children to theofopinion the parents, of the and 50% withdrawal parents, or change ofor and 50% withdrawal focus of the change ofdiscussion focus of the [17,54]. discussion The resolution of this discrepancy results in consequences in all areas of adolescent adjustment, [17,54]. academic achievement The resolution [55,56], of this conduct disorders discrepancy results in [26,57] beginning consequences as areas in all dependencies, internalized of adolescent adjustment,and externalized academic symptoms[55,56], achievement of mental healthdisorders conduct [38,58–62], etc. beginning as dependencies, internalized and [26,57] The 20%symptoms externalized referring to ofthe negotiating mental health parents seem [38,58–62], to respond to the personalistic parenting style, etc. to a communication The 20% referring styleto that favors autonomy, the negotiating parents adapting to the characteristics seem to respond of the children to the personalistic parenting and the style, sociocultural to context.style a communication To encourage that favorsthisautonomy, negotiating stance, parents adapting will find it helpful to the characteristics to children of the consider that and the sociocultural demand for autonomy context. To is encourage an adolescent thisrite [63]; thatstance, negotiating children need your parents support will find to maintain it helpful their to consider motivation that [64] and the demand for self-esteem autonomy is[65]; and to manage an adolescent the insecurity rite [63]; that childrenof liquid society need your [66]. to maintain support their Itmotivation can therefore[64]be andconcluded self-esteem that[65]; family andcounseling to manageprograms should the insecurity promote of liquid a parenting society [66]. style that caters It can to the three therefore bepersonal concluded dimensions that family of parents counseling andprograms children. There shouldshould promoteespecially be a focus a parenting style on the that optimal caters to theway of facing three personalarguments dimensions withofadolescents, parents and sochildren. that theyThere acceptshould the decisions thatbe especially are a being, made and with them, the healthy family lifestyles. focus on the optimal way of facing arguments with adolescents, so that they accept the decisions that In themade are being, following sections, and with them,the theanalysis healthy of the relationship family lifestyles. between the three variables (healthy lifestyles, In theparenting, followingand adolescent sections, autonomy) the analysis of thewill be presented. relationship between the three variables (healthy lifestyles, parenting, and adolescent autonomy) will be presented. 2. Method 2. Method A bibliographic search was carried out using three databases. Scopus was chosen in first place because it is one of the A bibliographic most was search prestigious carried international out using threedatabases, databases.despite Scopusits was multidisciplinary chosen in firstnature. place Psycinfoitwas because theofsecond is one database the most chosen prestigious due to the psychological international approach databases, despite of this study. The its multidisciplinary last nature. database to be selected was Pubmed, in which the largest number of quality articles Psycinfo was the second database chosen due to the psychological approach of this study. The last on different aspects ofto database healthy lifestyles be selected waswas expected. Pubmed, in For the the which search strategy, largest the same number keywords of quality were articles onused in all different databases—behavioral aspects autonomy, of healthy lifestyles adolescence, was expected. For teenager, the search healthy lifestyle, strategy, and keywords the same healthy habits—thereby were used in all databases—behavioral autonomy, adolescence, teenager, healthy lifestyle, and healthyofhabits— obtaining different results, as expected. The strategy is shown in Figure 7. The number articles thereby obtaining different results, as expected. The strategy is shown in Figure 7. The number of articles obtained with the key phrase healthy lifestyle was substantially reduced when crosschecking them with the keyword Parenting. Int. J. Environ. Res. Public Health 2020, 17, 5428 7 of 15 obtained with the key phrase healthy lifestyle was substantially reduced when crosschecking them with the keyword Int. J. Environ. Parenting. Res. Public Health 2020, 17, x 7 of 15 Figure 7. Bibliographic search algorithm. The The 4747 publications publications reviewed reviewed were were as as follows: follows: “acta“acta psychologica psychologica sinica,”sinica,” “adolescence,” “adolescence,” “adolescent “adolescent psychiatry: developmental and psychiatry: developmental and clinical clinical studies,” studies,” “aggressive “aggressive behavior,” behavior,” “annales “annales médico-psychologiques,” “annals of behavioral medicine: a publication médico-psychologiques,” “annals of behavioral medicine: a publication of the society of behavioral of the society of behavioral medicine,” medicine,” “asia “asiapacific pacificjournal of counselling journal and psychotherapy,” of counselling and psychotherapy,” “australian journal of educational “australian journal of and developmental educational psychology,” “behavior and developmental therapy,” psychology,” “behavioral “behavior psychology therapy,” / psicología “behavioral conductual:/ psychology revista internacional psicología conductual: clínica y deinternacional revista la salud,” “british clínicajournal y de la of salud,” educational psychology,” “british journal of“ca: a cancer educational journal for clinicians,” psychology,” “cahiers “ca: a cancer critiques journal de thérapie “cahiers for clinicians,” familiale critiques et de pratiques de réseaux,” de thérapie familiale“clinical et de child and family psychology review,” “clinical journal of pain,” “çocuk pratiques de réseaux,” “clinical child and family psychology review,” “clinical journal of pain,” ve gençlik ruh sa ğliği dergisi,” “child development,” “development and psychopathology,” “çocuk ve gençlik ruh sağliği dergisi,” “child development,” “development and psychopathology,”“developmental science,” “early human development,” “developmental “ethnic science,” and human “early racial studies,” “european development,” psychologist,” “ethnic and racial “family and community studies,” “european health: the journal of health promotion and maintenance,” “frontiers psychologist,” “family and community health: the journal of health promotion and maintenance,” in psychology,” “giornale di neuropsichiatria dell’età evolutiva,” “frontiers in psychology,” “giornale “health education,” “infancia di neuropsichiatria y aprendizaje: dell'età evolutiva,” journal “health for the education,” study of education “infancia and development,” y aprendizaje: journal for“infanzia the study e adolescenza,” of education “international and development,”journal of adolescence “infanzia e and youth,” “international adolescenza,” “internationaljournal journal of behavioral development,” of adolescence “journal of journal and youth,” “international addictions nursing,” of behavioral “journal of adolescence,” development,” “journal “journal of adolescent of addictions nursing,” research,” “journal“journal of behavioral of adolescence,” medicine,” “journal “journal of adolescent of consulting and clinical psychology,” “journal of child and family studies,” research,” “journal of behavioral medicine,” “journal of consulting and clinical psychology,” “journal “journal of family psychology: jfp: journal of the division of family psychology of the American of child and family studies,” “journal of family psychology: jfp : journal of the division of family psychological association (division psychology 43),” of “journal the Americanof interpersonal psychological violence,” association“journal of pediatric (division psychology,” 43) ,” “journal “journal of of interpersonal research on adolescence,” “journal of substance abuse treatment,” “journal violence,” “journal of pediatric psychology,” “journal of research on adolescence,” “journal of of youth and adolescence,” “kindheit substanceund abuseentwicklung: treatment,” zeitschrift “journalfür of klinische youth and kinderpsychologie,” adolescence,” “kindheit “motivation und and emotion,” entwicklung: “neuroethics,” zeitschrift für“neuropsychiatrie de l’enfance et de“motivation klinische kinderpsychologie,” l’adolescence,” and “new directions“neuroethics,” emotion,” for child and adolescent development,” “neuropsychiatrie “perspectives de l'enfance on psychological et de l'adolescence,” “new science: a journal directions of theand for child association adolescent for psychological development,” science,” “psichologija,” “perspectives “psychiatria on psychological hungarica,” science : a journal“revista of theiberoamericana association forde diagnóstico psychological yscience,” evaluación psicologica,” “social psychology of education: an international “psichologija,” “psychiatria hungarica,” “revista iberoamericana de diagnóstico journal,” “the americany psychologist,” “turk psikoloji dergisi,” “vulnerable children and youth evaluación psicologica,” “social psychology of education: an international journal,” “the americanstudies,” “youth and society.” Once the information psychologist,” “turk psikoloji wasdergisi,” read and“vulnerable systematized, the analysis children and youthcategories studies,” were used and “youth to delve into society.” the associations between the descriptors or keywords. In the qualitative analysis, Once the information was read and systematized, the analysis categories were used to delve into a total of 47 articles were reviewed. In the associations terms of between thethe aim of this descriptors orstudy, keywords.to pinpoint what type analysis, In the qualitative of parenting styles a total of 47promote articles adolescent were reviewed.adjustment In termsaccording of the aimtoofrecent research: this study, What has to pinpoint whatbeentypeinvestigated of parentingsostylesfar and what promote aspects remain unknown? Why do certain healthy adolescent lifestyles adolescent adjustment according to recent research: What has been investigated so far and what not continue into adulthood? What change aspects remain occurs if the way unknown? Whyofdo dealing certainwith discrepancies healthy adolescentbetween lifestyles parents and children not continue regarding into adulthood? What change occurs if the way of dealing with discrepancies between parents and children regarding adolescent autonomy is modified? The questions were used as a guide for the analysis of the articles which allowed the identification of relevant aspects. Int. J. Environ. Res. Public Health 2020, 17, 5428 8 of 15 adolescent autonomy is modified? The questions were used as a guide for the analysis of the articles which allowed the identification of relevant aspects. 3. Development and Discussion A total of 119 articles were identified. Following a review for duplicates, the number of articles was reduced to 90 and following a critical reading the number was even further reduced to 47. They are cited in the discussion and conclusions sections according to the color of the database (Scopus or Psycinfo). Pubmed articles have not been cited in the discussion because they refer to lifestyle aspects related to the physical dimension, whereas this study focused on the psychosocial aspects of adolescent adjustment. Based on the questions posed for this article, five analysis categories stood out: (1) healthy behavioral autonomy as a protective factor for adolescent lifestyles, (2) the meaning of healthy adolescent autonomy, (3) parenting styles that promote healthy adolescent autonomy, (4) how to solve the discrepancy between parents and teenage children, and (5) the interactive nature of the conflict resolution process. Firstly, some articles reinforce the main hypothesis, highlighting healthy behavioral autonomy as a protective factor against teenage risk behaviors [67], conduct disorders [68,69], and socio-emotional problems [70]. A possible explanation for this is that if the main evolutionary task of teenagers is to discover their own identity [43], if they feel that they take the lead of their behavior, they will not need to look for alternative environments in which to prove themselves. Sometimes the adjustment comes as a consequence of promoting school adjustment [71]. It could be because if your fellow students recognize your worth, you do not need to look for it in other groups outside of school [55,56]. The importance of timing is highlighted, given that behavioral autonomy in early adolescence is associated with crime [68,72], and with adolescent adjustment in the later stages. This confirms that prudent decisions are acquired gradually, at first on accidental issues and little by little on issues of greater relevance [17,53]. It also confirms that the three personal dimensions grow at different rates: they need time to integrate into coherent and healthy behavior [45,46]. In regard to the meaning of healthy adolescent autonomy, behaviors are addressed for which adolescents are considered autonomous [73] with parents being the main reference when making decisions, especially in matters of moral significance [74]. This means that, as indicated by the attachment theory, the bond with the parents does not need to break [75], something that has been studied in diverse cultures—[76] France, [77] Milan, and [78] Istanbul. In addition, closeness to the parent delays the appearance of antisocial disorders [79]. All this highlights the importance of an adequate gradation between the emotional, behavioral, and cognitive dimensions of autonomy, as proposed by the autonomy typology [48]. Thus, an attempt was made to define what is meant by healthy adolescent behavioral autonomy [80], studying its connection with self-esteem [67] and with different patterns of individuation [81]. A lack of healthy behavioral autonomy as a possible physical origin is also suggested in premature infants, due to a deficit in executive functions [79]. In each culture, the content and process of adolescent behavioral autonomy will acquire its own nuances. However, the attachment style seems decisive for adolescent adjustment. Secure attachment seems to be associated with healthy emotional and behavioral autonomy. Furthermore, healthy adolescent autonomy can be considered a prevention factor for substance dependence [42], specifically cannabis [82], for the recurrence of depression symptoms [83,84], and in general for externalizing symptoms of mental disorders, as shown by the recent review [85]. It is also associated with other aspects of physical health, such as headache [86], adherence to treatment in patients with diabetes [87] or their resilient attitude toward health [88], and in general, commitment to the treatment of chronic diseases [84]. These data reflect the difference between acting on extrinsic or intrinsic motivation. Behavior that is assumed in a personal way, through intrinsic motivation, manifests itself in all personal situations, regardless of the obstacles, and with behavioral autonomy. Int. J. Environ. Res. Public Health 2020, 17, 5428 9 of 15 The way in which adolescents achieve this type of healthy autonomy is linked to the parenting style, to the family environment [89]. For teenagers to sense a positive environment, it is imperative that time be spent together. In this sense, healthy autonomy can be associated with the parents’ schedule [90]. This influence of parenting on adolescent adjustment gradually decreases throughout early, mid, and late adolescence [69]. The indulgent style is associated with healthier adolescent autonomy in some countries [91], as indicated in the introduction, with adolescents raised in institutions achieving less autonomy than those who live with family [92]. From these results one can interpret that the development of behavioral autonomy is based on the safety provided by the parents, in the accepting way in which parents embrace and reason with their children regarding decisions. This feeling of belonging, of feeling loved, is also associated with adolescent self-esteem and adjustment. As part of the parenting style, the way to solve the discrepancy between parents and children regarding decision-making is especially linked to adolescent adjustment. To explain this, the theory of structural analysis of social behavior—SASB—[93] is used, considering autonomy as a teenager’s rite of passage [94], an achievement for which one must engage in negotiation [95]. These results are in line with the Piagetian theory, according to which, if there is no argument, ideas are not owned, behaviors are not assimilated. The evolutionary theories presented in the introduction corroborate these results. Arguing can be considered a teenage rite of passage, somewhat normative; but passive resolution of these arguments, without disagreement, without offering resistance or dialogue, will not allow for internalization, as exposed by the Piagetian theory, and therefore, the adopted lifestyles will not be maintained over time, as they have not been taken on at a personal level. The magnitude of the discrepancy depends on cultural beliefs, as indicated by the Social Dominance Theory [87], being greater in urban than in rural areas [59], and greater in immigrant minorities—in Europe and America—than in the families of the country [96,97]. These results show the influence of the environment. They may also reflect a way of resolving arguments in more traditional, non-negotiating settings [17,54]. In regard to the process of solving the conflict between parents and adolescents, the interactive nature of the process stands out; in fact, it is said that it is a catalyst for the transformation of family relationships [98] and that its resolution improves with a collaborative environment between parents and children [93]. This does not mean that solving the conflict falls entirely on parents allowing children to present their arguments, as it is also the children’s task to listen to their parent’s reasons. Examples of the reciprocity of the conflict resolution process can be seen in the following examples: to reduce symptoms of externalization, the same efficacy of results can be obtained either through parental education or adolescent therapy [99]; to reduce the climate of hostility in the family, one solution is to educate parents in self-regulation and social cognition [85], something that was predicted by the General Theory of Crime and Delinquency [70]. The quality of the relationship between parents and children depends on both. Once the results of the analysis are grouped into these five categories, one line of reasoning appears that can unite all of them together. This line of reasoning is described next, and a mental map is developed, a map that will guide the conclusion. Development of a Mental Map and Critical Argumentation of the Results Some constants were extracted from the analysis of the articles of the last four decades (1979–2000). Firstly, given the global nature of the review—different cultural settings—the influence of the parenting style on adolescent healthy autonomy, the meaning of this, and its relationship with a broader, biopsychosocial conception of healthy lifestyles acquires different nuances according to the time-space coordinates. • From a spatial point of view, parenting guidelines must be adapted to geographic contexts, and even in the same country, to urban or rural settings. At a micro level, one can observe that the unit of analysis of the relational environment has expanded, from a unidirectional approach Int. J. Environ. Res. Public Health 2020, 17, 5428 10 of 15 focused on the behavior of adolescents to a systemic approach attentive to the relational quality between parents and children—a quality that requires family interaction, which affects not only Int. J. Environ. Res. Public Health 2020, 17, x 10 of 15 the behavioral dimension, but also the affective and cognitive personality. •• Regarding Regarding the the temporal temporal coordinate, coordinate, timing timing stands stands out out on on the the one one hand, hand, and and on on the the other other hand hand there is the appropriate combination—asynchronous—of the facets of autonomy—behavioral, there is the appropriate combination—asynchronous—of the facets of autonomy—behavioral, cognitive, cognitive, or or emotional—in emotional—in each each adolescent adolescent stage: stage: early, early,mid, mid,and andlate. late.[63]. [63]. Moreover, Moreover, thethe persistence persistence ofof the the delay, delay,thethe gap gap between between the the desire desire for for adolescent adolescent autonomy and the areas areas of of freedom freedom given given byby the the parents, parents, isis established. established. That is why the strategies for solving these discrepancies become especially relevant strategies that include the involvement of all the the personal personal dimensions of parents and children. dimensions of parents and children. In In addition, addition,adolescent adolescent autonomy autonomy is linked to the variables is linked already mentioned to the variables in the introduction already mentioned in the by exposing the state of the art—academic achievement, conduct disorders, introduction by exposing the state of the art—academic achievement, conduct disorders, dependencies, externalizing and internalizing dependencies, symptoms of externalizing andmental health disorders, internalizing symptoms adherence of mentaltohealth the treatment of adherence disorders, chronic diseases, to the and acquiring treatment physical of chronic activityand diseases, habits [64]. physical activity habits [64]. acquiring Placing the obtained obtained conclusions conclusionsininthe thepersonality personalitydimensions dimensions allows allows them them to to be be integrated. integrated. In In this this way, way, applying applying themininprevention, them prevention,counseling, counseling,andandfamily familytherapy therapyprograms, programs, in in order order to promote healthy healthy lifestyles lifestyles becomes becomes moremore manageable. manageable. FigureFigure 88 shows shows this this integration: integration: Figure 8. Figure 8. Mind map and integration of results. 4. Conclusions 4. Conclusions The theoretical review carried out in this study allowed the identification of five analysis categories The theoretical review carried out in this study allowed the identification of five analysis that help understand this particular issue. categories that help understand this particular issue. (1) In the (1) In the family family lifecycle, lifecycle, ifif childhood childhood is is presented presented as as the the sensitive sensitive period period to to establish establish the relational the relational style according to the type of attachment [65], adolescence—with the style according to the type of attachment [65], adolescence—with the debut of formal thoughtdebut of formal thought and the desire for autonomy—emerges as a critical stage for the consolidation and the desire for autonomy—emerges as a critical stage for the consolidation of behavioral of behavioral autonomy and therefore autonomy andoftherefore healthy lifestyles of healthyinlifestyles the shortinand thelong shortterm. and long term. (2) (2) This comprehensive concept of a healthy lifestyle refers This comprehensive concept of a healthy lifestyle refers to to the the balance balance between between the the personal personal dimensions—affective, cognitive, dimensions—affective, and conative—and cognitive, and conative—and can can be be understood understood as as personal personal adjustment. adjustment. Therefore, adolescent Therefore, adolescent adjustment adjustment translates translates into into behavioral behavioral autonomy autonomy and and aa healthy healthy lifestyle. lifestyle. (3) Given the (3) Given the connection connectionof ofhealthy healthylifestyles lifestylesand andparenting, parenting,it itis isadvisable advisable to to sensitize sensitize families families in in regard to the personal and economic benefits of addressing regard to the personal and economic benefits of addressing healthy lifestyles in healthy lifestyles in all its biopsychosocial integrity, integrity, notnot limited to biorhythms, limited but also but to biorhythms, paying attention also payingto attention the psychological to the and social aspects psychological and related to timerelated social aspects managementto time and attitude towards management activities and attitude and activities towards relationships.and (4) relationships. During this developmental stage, the way in which parents and children resolve the discrepancy regarding (4) During thisthe areas of decision developmental that stage, thetheway adolescent in which yearns parentsforandischildren decisiveresolve for teenage children to the discrepancy regarding the areas of decision that the adolescent yearns for is decisive for teenage children to embrace family life habits as their own, so that they can internalize healthy lifestyles and with them promote adolescent adjustment. (5) The personalistic parenting style, being based on the personal dimensions—just like the healthy lifestyles—can easily be integrated and translated into family intervention and counseling Int. J. Environ. Res. Public Health 2020, 17, 5428 11 of 15 embrace family life habits as their own, so that they can internalize healthy lifestyles and with them promote adolescent adjustment. (5) The personalistic parenting style, being based on the personal dimensions—just like the healthy lifestyles—can easily be integrated and translated into family intervention and counseling programs. The indication is clear: to respect the interaction of the process, the involvement of parents and children, thereby avoiding a one-way approach as far as possible. Limitations and Outlook Despite the theoretical and methodological development of positive psychology in relation to the psychological factors of healthy lifestyles, some concepts require more research in order to be evaluated with greater reliability, such as the proactive attitude towards physical, emotional, financial, and environmental health, etc. A traditional objective trend in educational psychology is to guide, so that extrinsic motivation gradually gives way to intrinsic and transcendent motivation. A possible line of research would be to transfer this challenge to family counseling and intervention programs, showing the close connection between promoting adolescent autonomy and intrinsic motivation. To navigate the uncertain waves of a liquid society, many families turn to family counseling services while looking for guidelines to help educate their children, especially during the adolescent stage. The personalistic parenting style is characterized by adapting the dimensions of control, acceptance, and communication to each unrepeatable situation, deepening the perceptions of parents and teenage children in terms of who should make decisions regarding moral, socio-conventional, and private issues. It also implies designing a methodology of adjustment to bring the expectations of both parents and children closer and is therefore presented as a useful line of research to promote healthy lifestyles. 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