Co-occurrence Of Health Risk Behaviors Research Articles

Co-occurrence of and factors associated with health risk behaviors among adolescents: a multi-center study in sub-Saharan Africa, China, and India

Despite lifelong and detrimental effects, the co-occurrence of health risk behaviors (HRBs) during adolescence remains understudied in low- and middle-income countries. This study examines the co-occurrence of HRBs and its correlates among adolescents in sub-Saharan Africa, China, and India. A multi-country cross-sectional study was conducted in 2021-2022, involving 9697 adolescents (aged 10-19 years) from eight countries, namely Burkina Faso, China, Ethiopia, India, Ghana, Nigeria, Tanzania, and Uganda. A standardized questionnaire was administered to examine five types of HRBs-physical inactivity, poor dietary habits, smoking, alcohol consumption, and risky sexual behavior. Latent class analysis was employed to identify clustering patterns among the behaviors, and logistic regression was used to identify the correlates of these patterns. Three clusters of HRBs were identified, with Cluster 1 (27.73%) characterized by the absence of any specific risky behavior, Cluster 2 (68.16%) characterized by co-occurrence of physical inactivity and poor dietary habits, and Cluster 3 (4.11%) characterized by engagement in smoking, alcohol consumption, and risky sexual behavior. Relative to Cluster 1, being in Cluster 2 was associated with being female (aOR 1.20, 95% CI 1.09-1.32), not enrolled in education (aOR 0.84, 95% CI 0.71-0.99), and not engaged in paid work (aOR 1.23, 95% CI 1.08-1.41). Compared with those Cluster 1, adolescents in Cluster 3 were less likely to be female (aOR 0.41, 95% CI 0.32-0.54), be engaged in paid work (aOR 0.54, 95% CI 0.41-0.71), more likely to be older (aOR 7.56, 95% CI 5.18-11.03), not be enrolled in educational institution (aOR 1.74, 95% CI 1.27-2.38), and more likely to live with guardians other than parents (aOR 1.56, 95% CI 1.19-2.05). The significant clustering patterns of HRBs among adolescents in sub-Saharan Africa, China, and India highlights the urgent need for convergent approaches to improve adolescent health behaviors. Early life and school-based programs aimed at promoting healthy behaviors and preventing risky and unhealthy behaviors should be prioritized to equip adolescents with the tools and skills for lifelong well-being. Fondation Botnar (Grant #INV-037672) and Harvard T.H. Chan School of Public Health, partially funded this study.

Proactive automatised lifestyle intervention (PAL) in general hospital patients: study protocol of a single-group trial

IntroductionThe co-occurrence of health risk behaviours (HRBs, ie, tobacco smoking, at-risk alcohol use, insufficient physical activity and unhealthy diet) increases the risks of cancer, other chronic diseases and mortality more...

Sexual Initiation Before Age 14 and Co-Occurrence of Health Risk Behaviors Among Brazilian Adolescents: Data from the National School Health Survey 2015

Sexual Initiation Before Age 14 and Co-Occurrence of Health Risk Behaviors Among Brazilian Adolescents: Data from the National School Health Survey 2015

Can We Reverse this Trend? Exploring Health and Risk Behaviours of Grade 12 Cohorts of Ontario Students from 2013-2019.

Adolescents engage in multiple health risk behaviours that put them at risk of future chronic disease. By the time students graduate from secondary school, they may be engaging in behaviours that set them on a particular health trajectory. It is important to monitor the co-occurrence of health risk behaviours of cohorts of grade 12 students over time to highlight important areas for intervention. The purpose of this study was to examine trends in health and risk behaviours over six waves among subsequent cohorts of grade twelve students from Ontario, Canada. A total of 44,740 grade 12 students participated in the COMPASS study across the six waves (2013/14 to 2018/19), and self-reported movement (physical activity, screen time, sleep), dietary (fruit and vegetables, breakfast), and substance use (smoking, vaping, binge drinking, and cannabis use) behaviours. Over 91.0% of students reported engaging in three or more health risk behaviours, with increases in the number of students reporting inadequate sleep, not eating breakfast on every school day, and vaping over time. Although modest, the wave 6 cohort reported slightly more risk behaviours compared with the wave 1 cohort, highlighting the importance of multidimensional health promotion strategies across multiple settings.

Co-Occurring Health Risk Behaviors and Their Association with Self-Rated Health among Female College Students

ABSTRACT Background Existing research focuses on the co-occurrence of lifestyle-related health risk behaviors among college students. Although students’ self-reported health risk behaviors have been examined, students’ self-rated health and its association with these co-occurring health risk behaviors have been overlooked. Purpose: The goals of the current study were to identify levels of co-occurrence of health risk behaviors among female college students and to test the prediction that students with multiple co-occurring health risk behaviors would report poorer self-rated health. Methods: Data from an online survey that assessed the five selected health risk behaviors and self-rated health of undergraduate students at a liberal arts university in the northeast of the USA were analyzed. Results: High prevalence rates were found on all five risk behaviors and the majority of participants reported engaging in two or more co-occurring health behaviors. The inverse association between perceived health and level of co-occurrence of health risk behaviors was consistent with what was predicted. Discussion: Students’ perceived health should be considered in the examination of health risk behaviors among college students. Translation to Health Education Practice: These findings can inform efforts to provide Health Education and prevention programming on college campuses that incorporates multiple health behaviors. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars

Co-occurrence of Health Risk Behaviors Among Brazilian Adolescent Victims of Family Violence.

Although recent studies have related the occurrence of violence in childhood and adolescence with the adoption of health risk behaviors, there are no studies that quantify this co-occurrence among adolescent victims of family violence. Our objective was, therefore, to investigate the co-occurrence of health risk behaviors in these adolescent victims. Data from the National School Health Survey, collected in 2015, were used. Co-occurrence of risk behaviors-involvement in fights, substance use (alcohol, drugs, and tobacco), not wearing seat belts and helmets, inadequate food consumption-was analyzed using Venn diagrams, according to the victim's status and sex. The association between the four risk behaviors and victimization was investigated using multiple logistic regression. All the analyses were performed using Stata®13. We found an excess of risk behaviors among victims of family violence in both sexes. The co-occurrence of the four risk behaviors analyzed was higher among male and female adolescents, who were victims of family violence than in nonvictims. Family violence was associated with the adoption of risk behaviors, regardless of sex. This association was stronger as the number of risk behaviors adopted increased. The chance of engaging in one risk behavior was 1.32 (95% confidence interval (CI) = [0.88, 1.98]) and 1.24 (95% CI = [0.90, 1.72]) higher for boys and girls, respectively, who had suffered family violence. This increased to 7.76 (95% CI = [5.33, 11.29]) and 7.28 (95% CI = [5.20, 10.20]) when considering engagement in four risk behaviors. Identifying the prevalence of co-occurrence of health risk behaviors in vulnerable subgroups (such as victims of domestic violence) could help target broader interventions focusing on multiple risk behaviors.

Health Risk Behavior Patterns in a National Adult Population Survey.

Background: The aim of this paper is to analyze the co-occurrence of health risk behaviors (HRBs), namely, tobacco smoking, alcohol risk drinking, overeating, and physical inactivity, as well as their 16 combinations (patterns), which are stratified by age and gender. Methods: The data of 19,294 study participants, from a telephone survey among the adult general population of Germany that was conducted in 2012, were analyzed. Results: In adults, two or more of the four HBRs were found among 51.5% of females and 61.9% of males. The single most prevalent HRB pattern among all of the female (20.7, 19.6–21.8%) and male participants (18.2, 17.1–19.3%) was being overweight combined with a lack of physical activity, and its prevalence increased by 4% with each year of life. A multinomial regression analysis revealed that education was inversely associated with 11 of the 15 HRB patterns. The risk of having four, compared to zero, HRBs was 3.3 (2.5–4.4) for males relative to females. Conclusion: Similar to the findings from other western countries, the majority of the participants in this adult national sample from Germany had two or more HRBs. The most common of all possible HRB patterns was overweight and inactivity. The data confirm inverse relations between education and most HRB patterns.

Associations between perceived stress, socioeconomic status, and health-risk behaviour in deprived neighbourhoods in Denmark: a cross-sectional study

BackgroundPrevious studies have found that residents of deprived neighbourhoods have an increased risk of perceived stress compared to residents with similar sociodemographic and socioeconomic characteristics in non-deprived neighbourhoods. While stress may provide an explanatory pathway linking neighbourhood deprivation to health-risk behaviour, only limited research has been undertaken on whether perceived stress influences health-risk behaviour in deprived neighbourhoods. Moreover, it is uncertain whether perceived stress has a negative effect on the associations between socioeconomic status and health-risk behaviours in deprived neighbourhoods. The overall aim of this study was to compare perceived stress in deprived neighbourhood with that in the general population, and to examine whether perceived stress was associated with health-risk behaviours (including their co-occurrence) in deprived neighbourhoods. A further aim was to examine whether perceived stress modified the associations between socioeconomic status and health-risk behaviours.MethodsFour questions from the Perceived Stress Scale were used as indicators of perceived stress. Multiple logistic regression analyses were applied to cross-sectional data from 5113 adults living in 12 deprived neighbourhoods in Denmark. Data from 14,868 individuals from the nationally representative Danish Health and Morbidity Survey 2010 were used as a comparison group with regard to perceived stress.ResultsResidents of deprived neighbourhoods had higher odds of perceived stress than the general population. Associations between disposable income, economic deprivation, strain, and perceived stress were found in deprived neighbourhoods. Perceived stress was significantly associated with higher odds of health-risk behaviour, including a low intake of fruit or vegetables, daily smoking, physical inactivity, and the co-occurrence of health-risk behaviours, even after adjustment for demographic and socioeconomic characteristics. Perceived stress was more strongly associated with physical inactivity and having two or more health-risk behaviours among residents with medium/high socioeconomic status compared to residents with low socioeconomic status.ConclusionsOverall, the study showed a clear association between perceived stress and health-risk behaviour in deprived neighbourhoods. Future health promotion interventions targeting deprived neighbourhoods may benefit from incorporating stress reduction strategies to reduce health-risk behaviour. Further research is needed to fully understand the mechanism underlying the association between perceived stress and health-risk behaviour in deprived neighbourhoods.

The role of healthcare and education systems in co-occurrence of health risk behaviours in 27 European countries.

Contextual factors play an important role in health and related behaviours. This study aims to examine the association of co-occurrence of five health-risk behaviours with healthcare and education contextual factors using nationally representative samples from 27 European countries. Data were from Eurobarometer 72.3, 2009. The outcome was a count variable ranging from 0 to 5 indicating co-occurrence of five health-risk behaviours, namely smoking, excessive alcohol consumption, non-frequent fresh fruit consumption, physical inactivity and non-dental check-ups. Public expenditures on healthcare and education as a percentage of GDP and quality of healthcare and education at a country-level were used as contextual factors. A set of multilevel Poisson regression models were conducted to examine the associations between co-occurrence of health-risk behaviours and each of the contextual factors considering age, gender, marital status, urbanisation, individual socioeconomic positions (education, subjective social status or difficulty in paying bills) and GDP per capita. The total population was 23 842. Greater expenditures on healthcare and education, and better quality of healthcare systems had negative associations with co-occurrence of health-risk behaviours in the model adjusted for all individual demographic indicators. However, statistical significance disappeared after adjusting for socioeconomic indicators and GDP per capita. While the study highlights the importance of developing high-quality healthcare and education systems generously supported by public fund in relation to co-occurrence of health-risk behaviours, the influence of contextual factors in adopting health-related behaviours is probably attenuated by individual socioeconomic factors.

Longitudinal patterns and predictors of multiple health risk behaviors among adolescents: The TRAILS study

BackgroundMost studies on multiple health risk behaviors among adolescents have cross-sectionally studied a limited number of health behaviors or determinants. PurposeTo examine the prevalence, longitudinal patterns and predictors of individual and multiple health risk behaviors among adolescents. MethodsEight health risk behaviors (no regular consumption of fruit, vegetables or breakfast, overweight or obesity, physical inactivity, smoking, alcohol use and cannabis use) were assessed in a prospective population study (second and third wave). Participants were assessed in three waves between ages 10 and 17 (2001–2008; n=2230). Multiple linear regression was used to assess the influence of gender, self-control, parental health risk behaviors, parental monitoring and socioeconomic factors on the number of health risk behaviors adjusted for preceding multiple health risk behaviors (analysis: 2013–2014). ResultsRates of >5 health risk behaviors were high: 3.6% at age 13.5 and 10.2% at age 16. Smoking at age 13.5 was frequently associated with health risk behaviors at age 16. No regular consumption of fruit, vegetables and breakfast, overweight or obesity, physical inactivity and smoking predicted the co-occurrence of health risk behaviors at follow-up. Significant predictors of the development of multiple health risk behaviors were adolescents' levels of self-control, socioeconomic status and maternal smoking. ConclusionsMultiple health risk behaviors are common among adolescents. Individual and social factors predict changes in multiple health risk behaviors, showing that prevention targeting multiple risk behaviors is needed. Special attention should be paid to adolescents with low self-control and families with low socioeconomic status or a mother who smokes.

Prevalence and factors associated with the co-occurrence of health risk behaviors in adolescents

ObjectiveTo analyze the prevalence and factors associated with the co-occurrence of health risk behaviors in adolescents. MethodsA cross-sectional study was performed with a sample of high school students from state public schools in Pernambuco, Brazil (n=4207, 14–19 years old). Data were obtained using a questionnaire. The co-occurrence of health risk behaviors was established based on the sum of five behavioral risk factors (low physical activity, sedentary behavior, low consumption of fruits/vegetables, alcohol consumption and tobacco use). The independent variables were gender, age group, time of day attending school, school size, maternal education, occupational status, skin color, geographic region and place of residence. Data were analyzed by ordinal logistic regression with proportional odds model. ResultsApproximately 10% of adolescents were not exposed to health risk behaviors, while 58.5% reported being exposed to at least two health risk behaviors simultaneously. There was a higher likelihood of co-occurrence of health risk behaviors among adolescents in the older age group, with intermediate maternal education (9–11 years of schooling), and who reported living in the driest (semi-arid) region of the state of Pernambuco. Adolescents who reported having a job and living in rural areas had a lower likelihood of co-occurrence of risk behaviors. ConclusionsThe findings suggest a high prevalence of co-occurrence of health risk behaviors in this group of adolescents, with a higher chance in five subgroups (older age, intermediate maternal education, the ones that reported not working, those living in urban areas and in the driest region of the state).

Multilevel analysis of health risk behaviour in Czech teenagers

The health risk behaviour (HRB) of teenagers, especially substance abuse, is one of the most serious problems of today’s public health arena. The aim of this paper is to assess the extent of the multiple health-risk behaviours within the teenage population and to analyse the role of the individual and family structure as well as educational and geographic factors in the combination of their risk behaviours (frequency of smoking, alcohol intoxication and lifetime cannabis use). The data for this paper come from an on-line survey among elementary school students in 19 selected schools in Prague and 18 other elementary schools throughout Czechia. Family composition and relationship with the adolescent’s mother were confirmed as significant variables associated with risk behaviours. Adolescents coming from two-parental families had a significantly lower prevalence rate of all three HRB than students living with only one parent or in zero-parent families. Respondents who declared the highest satisfaction with the relationship with their mother had the lowest prevalence of all three HRB characteristics. Regarding leisure time activities, going out with friends clearly increased the risk of HRB, and having specific hobbies reduced the risk of HRB’s. The strongest association revealed was the one between the co-occurrence of health risk behaviours and going out with friends. Significant associations with the aggregate municipality characteristics were confirmed only in the case of marijuana use. It is thus mainly the family and peer domain where the prevention and health policies have to focus.

Drug Use Risk Behavior Co-Occurrence Among United States High School Students

Purpose: Prevalence estimates for drug use health risk behaviors among high school students are widely available, but relatively few studies describe how and to what extent these risk behaviors occur together. Furthermore, little research has examined whether the co-occurrence of health risk behaviors varies by key demographic characteristics such as gender and race/ethnicity. The purpose of this study is to develop prevalence estimates for combinations of co-occurring drug use health risk behaviors among United States high school students, and to investigate demographic differences in co-occurrence. Methods: Survey data from a representative sample of United States high school students (N = 16,410) were analyzed. This research is on four health risk behaviors: tobacco use, alcohol use, marijuana use, and cocaine use. Explicit descriptions of the risk behavior combinations that students engage in are presented, and comparisons are made among gender, grade, and racial/ethnic student groups using chi-squared tests. Results and Conclusions: Study results suggest that most adolescents do not engage in multiple risk behaviors simultaneously and that race, gender, and grade level significantly impact the prevalence of co-occurring risk behaviors.

High Calorie, Low Nutrient Food/Beverage Intake and Video Gaming in Children as Potential Signals for Addictive Behavior

Little is known about the co-occurrence of health risk behaviors in childhood that may signal later addictive behavior. Using a survey, this study evaluated high calorie, low nutrient HCLN intake and video gaming behaviors in 964 fourth grade children over 18 months, with stress, sensation-seeking, inhibitory control, grades, perceived safety of environment, and demographic variables as predictors. SEM and growth curve analyses supported a co-occurrence model with some support for addiction specificity. Male gender, free/reduced lunch, low perceived safety and low inhibitory control independently predicted both gaming and HCLN intake. Ethnicity and low stress predicted HCLN. The findings raise questions about whether living in some impoverished neighborhoods may contribute to social isolation characterized by staying indoors, and HCLN intake and video gaming as compensatory behaviors. Future prevention programs could include skills training for inhibitory control, combined with changes in the built environment that increase safety, e.g., implementing Safe Routes to School Programs.

Co-occurrence of health-risk behaviors in students in two north Chinese cities

目的 探讨城市青少年健康危险行为聚集模式及特点.方法北方两所大城市随机抽取市区初二、高二和大学二年级7230名学生进行集体自填匿名问卷调查.以10种主要健康危险行为为聚类指标,采用样本聚类方法分别对男、女学生进行聚类.结果根据行为发生严重程度和高发行为特点男、女生分别隶属于低危险组(男44.0%;女49.5%)、中度危险组(模式2组:男24.8%,女25.4%;模式3组:男16.3%,女12.1%)和高危险组(男14.8%;女12.9%)4类健康危险行为聚集模式人群.吸烟和饮酒在男、女生某中度危险组中高发,男、女吸烟率分别为26.8%和女8.5%;饮酒率为100%,远高于该人群总体水平,吸烟饮酒呈聚集现象;女生高危险组中自杀意念、不健康减肥和滥用药物三类内隐性行为发生率分别为100%,8.4%和7.5%,远高于人群总体水平和其他3组,表明这三类行为呈现聚集性,而男生高危险组中大部分行为高发,呈现外显问题行为和内隐性行为的高度聚集现象.结论应针对青少年中某些行为聚集发生和聚集方式多样特点,根据性别特点,有针对性地开展一级、二级、三级预防等综合性预防干预措施。

Prevalence and Co-occurrence of Health Risk Behaviors among High-Risk Drinkers in a Primary Care Population

Background. Approximately 10% of patients seen in the primary care setting meet criteria for high-risk (HR) drinking. Little data are available about the co-occurrence of other risk behaviors (RBs) in this population. This study examines the co-occurrence of smoking, poor diet, and sedentariness, and several change-related variables, among 479 HR drinkers participating in Project Health, a NIAAA-funded study testing the effectiveness of a provider-delivered intervention to reduce HR drinking.Method. Data were collected at study entry via standardized interview and questionnaire.Results. The prevalence of additional RBs among HR drinkers was smoking, 35%; poor diet, 28%; and sedentariness, 44%. In addition to HR drinking, 67% of participants had at least one RB, and 61% reported smoking, sedentariness, or both. Perception of drinking as a problem was generally low (20%), as was intention to change drinking. Seventy-two percent of participants with multiple RBs perceived at least one of these RBs as a problem. Younger, unmarried, less-educated, blue-collar, and non-working participants were more likely to have multiple RBs than white-collar workers.Conclusion. Additional RBs are common among HR drinkers and may increase their already elevated health risks. Implications of these findings for interventions integrating multiple RBs into primary care settings are discussed.

Co-occurrence of health-risk behaviors among adolescents in the United States

Although it is common for adolescents to experiment with several health-risk behaviors before reaching adulthood, little is known about the co-occurrence of these behaviors. The purposes of this study were to determine the co-occurrence of specific health-risk behaviors among a nationally representative sample of adolescents, and to examine whether the distribution of multiple risk behaviors varies by age, sex, and school enrollment status. This study analyzed survey data from a United States national probability sample (n = 10,645) of youth aged 12-21 years. Survey items measuring current seat belt use, weapon carrying, tobacco, alcohol, and other drug use, and sexual behavior were included in the analysis. The majority of adolescents aged 12-17 years did not engage in multiple health-risk behaviors. However, the prevalence of multiple risk behaviors increased dramatically with age. While only 1 in 12 adolescents aged 12-13 years engaged in two or more of these behaviors, one-third of those aged 14-17 years and half of the college-aged youth (18-21 years) did so. Male respondents and out-of-school youth aged 14-17 years were more likely to engage in multiple health-risk behaviors than were other respondents. These results suggest that the likelihood that adolescents engage in multiple health-risk behaviors is related to age and that many adolescents engage in these behaviors serially rather than at the same time.