Clustering of health-related behaviours and its relationship with individual and contextual factors in Portuguese adolescents: results from a cross-sectional study

Constança Soares Dos Santos,Isabel Loureiro,Carla Nunes,João Picoito

doi:10.1186/s12887-020-02057-1

Abstract

BackgroundHealth behaviours are shaped early in life and tend to occur in complex specific patterns. We aimed to characterise these patterns among Portuguese adolescents and their association with individual and contextual factors.MethodsThis study was based in the Portuguese 2009/10 survey of Health Behaviour in School-Aged Children Study, comprising 4036 adolescents. Individuals were grouped using two-step cluster analysis based on 12 behaviours regarding diet, physical activity, screen use and substance use. The association between clusters and individual and contextual factors was analysed using multinomial regression.ResultsThe median age was 13,6, and 54% were female. Overweight and obesity were highly prevalent (25%). We identified four behavioural clusters: “Active screen users”, “Substance users”, “Healthy” and “Inactive low fruit and vegetable eaters”. Sociodemographics varied across clusters. The “Substance users” and “Active screen users” clusters were associated with poor family communication, academic performance and school attachment and violent behaviours, and the “Inactive low fruit and vegetable eaters” were associated with lower socioeconomic status.ConclusionThe understanding of these health-compromising patterns and their social determinants is of use to Public Health, allowing tailored health-promoting interventions. Further research is needed to understand how cluster membership evolves and its influence on nutritional status.

Highlights

Health behaviours are shaped early in life and tend to occur in complex specific patterns
We found that the “Healthy” cluster was predominantly female and that boys were twice more likely to be “Active screen users” and more likely to be “Substance users”, the latter association disappeared after adjusting to contextual factors
A review focusing on behavioural change during adolescence through school-based interventions concluded that most interventional studies target one of two groups of behaviours: substance use and energy balance [49]

Summary

Introduction

Health behaviours are shaped early in life and tend to occur in complex specific patterns. Unhealthy behaviours like smoking, alcohol consumption, physical inactivity and unhealthy diet tend to persist into adulthood, contributing to higher risks of non-communicable diseases, like obesity, metabolic syndrome, diabetes and cardiovascular disease [4]. They are associated with increased morbimortality and are significant threats to Public Health. In adolescence, these unhealthy behaviours tend to cluster, with multiple synergic risk factors occurring together [5]. Focusing on these complex clusters rather than on single behaviours may be more effective when planning public health interventions

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