Abstract
ObjectiveWe aimed to systematically review and synthesise evidence on the clustering of a broad range of health-related behaviours amongst 11–16 year olds.MethodA literature search was conducted in September 2019. Studies were included if they used cluster analysis, latent class analysis, prevalence odds ratios, principal component analysis or factor analysis, and considered at least three health-related behaviours of interest among 11–16 year olds in high-income countries. Health-related behaviours of interest were substance use (alcohol, cigarettes and other drug use) and other behavioural risk indicators (diet, physical activity, gambling and sexual activity).ResultsThe review identified 41 studies, which reported 198 clusters of health-related behaviours of interest. The behaviours of interest reported within clusters were used to define eight behavioural archetypes. Some included studies only explored substance use, while others considered substance use and/or other health-related behaviours. Consequently, three archetypes were comprised by clusters reporting substance use behaviours alone. The archetypes were: (1) Poly-Substance Users, (2) Single Substance Users, (3) Substance Abstainers, (4) Substance Users with No/Low Behavioural Risk Indicators, (5) Substance Abstainers with Behavioural Risk Indicators, (6) Complex Configurations, (7) Overall Unhealthy and (8) Overall Healthy.ConclusionStudies of youth health behavioural clustering typically find both a ‘healthy’ cluster and an ‘unhealthy’ cluster. Unhealthy clusters are often characterised by poly-substance use. Our approach to synthesising cluster analyses may offer a means of navigating the heterogeneity of method, measures and behaviours of interest in this literature.
Highlights
The clustering of health behaviours has important consequences for health as the risks associated with engagement in any particular behaviour may increase, or decrease, depending on which other behaviours an individual engages in [1]
Unhealthy clusters are often characterised by poly-substance use
Studies consistently find that small minorities of young people engage in multiple unhealthy behaviours, including polysubstance use, or substance use alongside multiple other risk behaviours, such as having a poor diet, lacking exercise or engaging in sexual activity
Summary
The clustering of health behaviours has important consequences for health as the risks associated with engagement in any particular behaviour may increase, or decrease, depending on which other behaviours an individual engages in [1]. Analyses of the clustering of health behaviours are interested in whether individuals participate in each of a set of health behaviours and whether an exhaustive set of ‘clusters’ or ‘behavioural types’ can summarise the patterns of participation seen across a population [2]. Three clusters may broadly summarise the patterns of participation in a population: individuals either (i) smoke, drink heavily, and use illicit drugs; (ii) drink heavily; (iii) do none of these behaviours. Analyses of clustering investigate underlying associations between concurrent behaviour [2] and they seek to exhaustively classify patterns of behaviour across the whole population rather than describing patterns in one part of the population (e.g. the tendency for illicit drug users to smoke)
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