Adolescent High-risk Behaviors Research Articles

Traumatic Experiences and High-Risk Behaviors Among Runaway Youth in Residential Care Centers: The Influence of Sensation Seeking and Impulsivity

ABSTRACT Running away from a residential care center is a worrying reality due to high-risk behaviors adopted by many youths such as delinquency, substance abuse, risky sexual behavior and risky driving. Because youth in residential care may have been exposed to a variety of traumatic experiences (e.g. emotional, physical, and sexual abuse, emotional and physical neglect), the purpose of this study is first, to examine the association between these experiences and high-risk behaviors in adolescents in residential care. Second, this study aims to explore the explanatory mechanisms (impulsivity and sensation-seeking) behind the adoption of high-risk behaviors in runaway and non-runaway youth in residential care. To this end, 125 adolescents aged 15–17 who had run away at least once and 75 who had never run away from their residential care center completed self-report questionnaires about traumatic experiences, high-risk behaviors, sensation seeking and impulsivity. To address the study objectives, correlation and conditional mediation analyses were conducted. Results indicate that sensation seeking influences the relationship between traumatic experiences and delinquency, as well as drug and alcohol use. Thus, addressing sensation seeking tendencies could reduce the risks inherent in the adoption of certain high-risk behaviors among youth in residential care centers.

Compensatory prosocial behavior in high-risk adolescents observing social exclusion: The effects of emotion feedback

Although exposure to violence has been consistently associated with deficits in prosocial behavior among adolescents, effective methods of mitigating these deficits have yet to be identified. The current investigation tested whether prosocial behavior could be promoted by providing adolescents with feedback about the emotional states of others and whether the effects of feedback varied between adolescents who had versus had not experienced violence in the home or in the community. Adolescents aged 8 to 17 years with (n = 87) and without (n = 61) histories of violence exposure completed a virtual social exclusion ball-tossing paradigm in which information about an excluded peer’s emotions (sad, angry, or neutral) was experimentally manipulated. Among adolescents with histories of violence exposure, those who received feedback that the peer was sad due to being excluded compensated by throwing the ball more often to that peer. In contrast, adolescents without histories of violence exposure did not engage in compensatory prosocial behavior, instead maintaining a relatively even number of tosses to all players. Findings offer new insight into simple potential methods of eliciting prosocial behavior in adolescents for whom such responding may be compromised and may provide a potential starting point for interventions.

Effectiveness of online integrative trans-diagnostic treatment on internet addiction and high-risk behaviors in female adolescents with borderline personality disorder with comorbid depressive disorder.

Based on research, borderline personality disorder is associated with many behavioral and emotional problems, including Internet addiction and high-risk behaviors. On the other hand, integrative trans-diagnostic treatment, by targeting trans-diagnostic factors in emotional pathology, is considered a suitable treatment for comorbid psychological pathologies. Also, since in adolescence, the opinion of others about oneself is more important, online therapy has the advantage of protecting them from the fear of stigma and shame in the face of others' judgments. Therefore, the aim of the current research was to investigate the effectiveness of online integrative trans-diagnostic treatment on the internet addiction and high-risk behaviors in adolescents with borderline personality disorder. The current research was applied and quasi-experimental in a pre-test-post-test manner with a control group. The research sample included 40 female adolescents with borderline personality disorder who were randomly divided into two groups of 20 people, experimental and control groups. The criteria for entering the research included the age range of 12 to 18 years, female, confirmation of the disease by a psychologist, not receiving other psychological treatments in the last 3 months, and having a smartphone to participate in the online group. Substance abuse, any serious mental and physical illness/disorder that interferes with treatment, and failure to attend more than two sessions in therapy sessions were some of the exclusion criteria.The participants were tested on the scales of internet addiction and high-risk behaviors. Then, the treatment plan based on online integrative trans-diagnostic group therapy was presented to the participants of the experimental group online in 9 two-hour sessions. The control group was placed on the waiting list until the completion of the treatment sessions and the post-test implementation, and after the post-test implementation, they received the treatment. Then, their scores were measured, after completing the treatment, and a three-month follow-up period. Descriptive statistics and covariance test were used to analyze the data. Patients showed a clear improvement in the severity of internet addiction and high-risk behavior symptoms. So that the scores of internet addiction and high-risk behaviors in the experimental group after receiving the treatment, as well as after a three-month follow-up period, were significantly reduced (p < 0.001). These results show that online integrative trans-diagnostic therapy can be an effective treatment option for reducing some symptoms of risky behaviors and internet addiction in adolescents with borderline personality disorder and should be studied further. It is noteworthy that the limitations of this study were the available sampling method, the use of a unisex sample of female patients, and the short-term follow-up period, which makes it difficult to generalize the results.

Opportunities to improve high-risk behavior screenings during well-child examinations.

Nurse practitioners serve an essential role in the completion of age-appropriate adolescent high-risk behavior screenings including tobacco/nicotine, alcohol, illicit drug use, and sexual activity during well-child examinations (WCEs). Midwestern adolescents demonstrate a suboptimal rate of engaging in annual preventative medical visits in comparison to national data. This mixed-methods quality improvement pilot sought to evaluate health care providers' beliefs, general clinic processes, and the overall quality of WCEs among adolescents aged 11-17 years in two midwestern primary care clinics. Quantitative data were obtained through queried reports and manual electronic health record chart audits. Qualitative data were obtained through focus group interviews. Interventional strategies included providing education to key stakeholders regarding data analysis findings indicating process deficiencies regarding adolescent WCEs. Project members championed integration of advanced practice nurses as leaders of change within urban, multisite tertiary health care systems. Results demonstrate that the lack of standardized assessment during an adolescent WCE can lead to fragmentation of high-risk behavior screenings. This quality improvement pilot demonstrates the need for nurse practitioners to be at the forefront of interprofessional committees advancing the implementation of evidence-based guidelines and practice improvement initiatives. Standardization of high-risk behavior screening as part of the WCE in adolescence provides the foundation for health promotion and chronic disease prevention spanning into adulthood.

The effectiveness of Adler's parenting education program on school bonding and adolescent high-risk behaviors

Aim: The aim of this study was to determine the effectiveness of Adler's parenting education program on school bonding and high-risk behaviors of adolescents. Methods: The present research method was quasi-experimental with pre-test, post-test design and follow-up with a control group. The statistical population of this research is. The statistical population of the study is 665 mothers of all female high school students in East Bandapi, Babol, who are studying in the academic year of 2009-2010, of which 60 are students with high-risk behavioral problems and their mothers The input criteria of the study were consistent with purposive non-random sampling method and were randomly divided into two groups of 15 experimental and control. The experimental group received a parenting training program based on the Bruegel training package (2016) in 8 sessions of 120 minutes per week. Before and after the intervention, the school connection questionnaire (Rezaei Sharif, 2012) and the high-risk behaviors questionnaire (Zad Mohammadi et al., 1390) was performed in both groups. Data were analyzed by repeated measures analysis of variance using SPSS-22 software. Results: The results of this study showed that the Adler parenting program training program increased parental care bond (F = 5.53, P &lt;0.001), extreme support (F = 70.50, P &lt;0.001) and Reduction of high-risk behaviors of adolescents (F = 120.30, P &lt;0.001) was effective. Conclusion: It can be concluded that Adler's parenting education program increased the bond with school and reduced effective high-risk behaviors of adolescents.

Childhood Trauma as a Risk Factor for High Risk Behaviors in Adolescents with Borderline Personality Disorder.

Objective: Childhood trauma is associated with many major short-term and lifelong consequences, such as deterioration of mental health, higher frequency of affective dysregulation, changes in consciousness and attention, personality disorders, etc. Therefore, this study aims to examine childhood trauma as a possible factor in the incidence of high risk behaviors in adolescents with borderline personality disorder (BPD). Method : 120 individuals aged 12-18 years were selected based on purposive sampling and included in the research group (including 60 BPD adolescents and 60 non-BPD adolescents). After receiving ethical approval from official institutions, data was collected from the participants through demographic, childhood trauma, sexual addiction screening, eating attitudes, RAFFT, and suicidal behavior questionnaires. The collected data was analyzed using chi-square test, independent t-test, prevalence, odds ratio and correlation analyses using the SPSS V21.0 software. Results: All adolescents with BPD had experienced some forms of psychotraumatic events in childhood. The BPD group experienced more traumatic events than the non-BPD group (P < 0.05). After controlling for gender, age and years of education, all differences remained significant. Furthermore, statistically significant correlations were found between the scores of the emotional abuse and eating disorders scales in the group of girls with BPD (r = 0.788, P < 0.01). Moderate correlations were discovered between emotional abuse and suicidal behaviors in boys with BPD (r = 0.641, P < 0.01). Moreover, it was found that the most significant factors in the formation of addictive behaviors among adolescents with BPD were emotional abuse (r = 0.527) and emotional neglect (r = 0.513, P < 0.05). Conclusion: These findings reinforce the role of childhood trauma in the formation of BPD symptoms during adolescence. Successful detection of the earliest risk factors in the form of childhood trauma and its different forms can provide specific high risk behavior targets for early intervention.

Investigating the relationship between high-risk behaviors and mental health in adolescents in Rabor city, Iran.

High-risk behaviors (HRBs) represent significant health threats for adolescents and significantly affect adolescents' mental health. Adolescents often engage in risky behaviors. The present study was conducted to investigate the relationship between high-risk behaviors (HRBs) and mental health in adolescents in Rabor. The present study was a cross-sectional analytical study that was performed on 334 girl and boy students aged 12-18years in Rabor city in 2021. In this study, adolescents answered high risk behaviors and mental health questionnaires. Data were analyzed using SPSS-26 software and the spearman correlation coefficient and linear regression analysis (univariate and multivariate analysis) were used to analyze the data. In this study, the mean age was 15.25±1.78. The findings indicate that smoking and hookah use were higher in boys than girls. Among the demographic variables, age and level of education had a positive and significant relationship with HRBs and mental health (p<0.05). The mean score of total mental health for all subjects was 12.83±10.82. The variables of age, sex, marital status of parents, the number of children in the family, educational level, smoking, hookah, and alcohol have been determined as influential and facilitating factors in HRBs of adolescents. Father's literacy was considered as a facilitator and age variables, alcohol consumption and parents' marital status were considered as deterrents to mental health. The present study showed that the male gender is one of the risk factors for alcohol, smoking and other substances, the tendency to high-risk sexual behaviors, depression, and suicide in adolescents. Among the determinants of the tendency to HRBs in adolescents, psychological variables are of particular importance at the individual, social, and family levels. Good mental health can improve quality of life, while poor mental health can make it worse.

Increasing Health Literacy Among Residents at a Juvenile Temporary Detention Center.

Health literacy is a nationwide public health concern. Low health literacy in adolescents is related to increased adolescent high-risk behaviors, which can negatively affect their overall health. A quality improvement health literacy project was developed, implemented, and evaluated in a juvenile temporary detention center. Stakeholders identified pertinent health-related topics for discussion, including female body anatomy, sexual health, consent, pornography, sex trafficking, smoking, and anger management. Toolkits and pretest/posttest questionnaires guided weekly group sessions. Youth engaged in content during each session. Group health literacy scores were examined to evaluate the program. Group comments were debriefed by facilitators after each session; 119 youth residents participated. Positive increases in health literacy and health knowledge were observed in all sessions for all groups. Interactive health education programs for incarcerated youth can improve their health literacy and health knowledge and begin a path to decrease health inequities in this vulnerable population.

Investigating the Relationships Between Spiritual Well-being and Other Well-being Dimensions, and Attitude Toward High-risk Behaviors in Adolescents, with Emphasis on the Mediating Role of Personality Traits

Background: Research indicates the increasing prevalence of high-risk behaviors among adolescents, which may have many causes. Objectives: The present study aimed to investigate the relationship between spiritual well-being and other dimensions of well-being and the tendency for high-risk behaviors in adolescents, with an emphasis on the mediating role of personality traits. Methods: This is a descriptive and correlational study. The statistical population of the study consisted of all high school students in the second semester of the academic year 2018 - 2019 in the city of Tehran. Data collection tools were Spiritual, Psychological, Social, and Physical Well-being questionnaires, Iranian Adolescent Risk questionnaire, and PID-5 Personality Characteristics questionnaire-short version. SPSS V.22, R programming V.3.6, and AMOS V.24 were used to analyze the data. Results: The results showed that there is a significant relationship between spiritual well-being and other aspects of well-being, i.e., physical health (r = 0.28), social well-being (r = 0.39), psychological well-being (r = 0.44), with P &lt; 0.01 for all. There was also a significant negative relationship between spiritual well-being and components of high-risk behavior (r = 0.48, P &lt; 0.01). In addition, personality traits were found to play a significant role as a mediating variable in the relationship between spiritual well-being and high-risk behaviors. Conclusions: Spiritual well-being is a factor affecting other aspects of well-being and reducing risky behaviors, and personality traits play an important role in mediating the relationship between spiritual well-being and other dimensions of well-being and high-risk behaviors.

Predictive Model of High-risk Behaviors in Iranian Male Adolescents Based on Psychological Motivation

Background: Awareness of people’s motivations for committing high-risk behaviors helps to explain the underlying causes and provides a framework for their use in preventive and therapeutic interventions. Objectives: This study aimed to evaluate the predictive model of high-risk behaviors in adolescents based on their motivations. Methods: The present research has a correlational design and uses structural equation modeling. The sample included 450 male students selected through a convenience sampling method to complete the Iranian Adolescents’ Risk-taking and Motives for Risk-taking scale. Data were analyzed using structural equation modeling. Results: The results showed that thrill-seeking, calculation, audience control, irresponsibility, and hedonistic motivation had significant relationships with high-risk behaviors. Also, except for attention-seeking, other motivations could significantly contribute to the prediction of high-risk behaviors. Also, the motivations had the strongest impact on alcohol consumption and the minimum impact on smoking. Finally, motivations generally explained 44% of the high-risk behaviors variance. Conclusions: Considering the role of motivations in doing high-risk behaviors, more attention should be given to these factors in preventive and therapeutic interventions.

The Development of an Integrated Psychotherapy Model based on Religious-Psychological Teachings with Islamic Approach and Evaluating its Effectiveness on Reducing the Tendency to High-Risk Behaviors in Adolescents

The Development of an Integrated Psychotherapy Model based on Religious-Psychological Teachings with Islamic Approach and Evaluating its Effectiveness on Reducing the Tendency to High-Risk Behaviors in Adolescents

Tendency to High-Risk Behaviors in Adoles-cents and its Related Factors in Bushehr, 2019

Tendency to High-Risk Behaviors in Adoles-cents and its Related Factors in Bushehr, 2019

Identifying What and How High-Risk Behaviors in Adolescents Engaged in High-Risk Behaviors: A Phenomenological Study

Identifying What and How High-Risk Behaviors in Adolescents Engaged in High-Risk Behaviors: A Phenomenological Study

Association of Social Media Use and High-Risk Behaviors in Adolescents: Cross-Sectional Study.

BackgroundPrevious studies have demonstrated the prevalence of social media use and identified the presence of high-risk behaviors among adolescents, including self-harm and sharing of sexually explicit messages.ObjectiveThis study aimed to identify patterns in the amount of time spent on social media by adolescents who engage in high-risk behavior and the extent to which they use social media as a platform for sharing such behaviors.MethodsThis was a descriptive cross-sectional study of 179 adolescents seen in a pediatric clinic at an urban medical center. We used an anonymous self-report survey to obtain demographic characteristics, rates of self-harm thoughts and behaviors, sharing of sexually explicit messages, and social media use as determined by total hours spent on social media per day and the number of applications used.ResultsMost adolescents reported spending 3 to 5 hours on social media each day and using 3 or more social media applications. Almost 1 in 8 (22/179, 12.3%) adolescents self-reported having ever engaged in self-injury with a mean age of onset of 11.8 years. Over a quarter (49/179, 27.4%) of adolescents reported sharing sexually explicit messages. Relative risk of engaging in self-injury and or sharing sexually explicit messages increased with the use of 4 or more social media applications (1.66; CI 1.11-2.48).ConclusionsResults show a relationship between the number of social media applications used and increased rates of high-risk behaviors. We identified relevant risk factors that clinicians can use to screen for high-risk behavior and parents can monitor to encourage education about healthy online practices.

Development and Validation of Smoking Abstinence Self-efficacy Scale among Iranian Female Adolescents

Background: Among different factors, self-efficacy is one of the most suitable components for predicting smoking behavior among adolescents. Therefore, it is essential to design a native tool to measure this high-risk behavior in adolescents and implement prevention programs in this age group. Aim: This study aimed to design and validate a smoking abstinence self-efficacy questionnaire in female adolescents. Method: In this methodological study, a comprehensive literature review was conducted, and the available similar questionnaires were used to prepare the items. In total, 351 female schoolchildren were selected by convenience sampling in Mashhad, Iran, between October 2017 and January 2018. Face and content validity and construct validity were applied for psychometric evaluation of the developed tool. The reliability of the tool was tested by internal consistency. Results: The final version of the smoking abstinence self-efficacy scale in Iranian female adolescents includes 16 items after a psychometric evaluation. The content validity of the tool was obtained at 0.99. Moreover, exploratory factor analysis explored three factors of emotional, social, and high-risk situations explaining 60% of the variance. Cronbach's alpha coefficient of the questionnaire was estimated at 0.94. Implications for Practice: The smoking abstinence self-efficacy scale is a valid and reliable tool among Iranian female adolescents derived from the native context of this group of people which can examine smoking abstinence self-efficacy in three dimensions of emotional, social, and high-risk situations. Moreover, it can identify adolescents with different levels of smoking abstinence self-efficacy.

The Effect of Peer Education on Health Promotion of Iranian Adolescents: A Systematic Review

Background: Peer education is one of the most effective strategies for changing behavior in adolescents, which provides the unique learning opportunities for promote health behaviors. The aim of this study was to systematically review the effect of peer education on health promotion of Iranian adolescents. Materials and Methods: In this systematic review, all interventional studies were searched from Web of Science, Scopus, Embase, Cochrane, Medline (via PubMed) as English databases and SID, Magiran and Irondoc as Persian databases using keywords such as adolescent, teenager, student, peer group, education, health and Iran between January 2000 to October 2018. Two reviewer studied the full text of the articles and their main findings were extracted and categorized. The quality of the articles were checked and verified using the Effective Public Health Practice Project (EPHPP) tool. Results: Finally, 20 articles (with total 6,652 adolescents) which met inclusion criteria were investigated and reviewed systemically in four categories including the effect of peer education on prevention of diseases, mental health, nutritional behaviors, and prevention of high-risk behaviors in adolescents. In all categories, the results showed the equal or greater effect of peer education on knowledge, attitude, practice, self-efficacy and health behavior of adolescents compared to other methods such as education by teacher, health personnel, lecture, pamphlet and booklet. Only effect of education by the physician was more than peer education. Conclusion: According to the results, peer education improves the knowledge, attitude, health behavior, and self-efficacy of adolescents and as a result, it will promote the adolescent health.

A survey on adolescent health information seeking behavior related to high-risk behaviors in a selected educational district in Isfahan.

BackgroundsThe characteristics and conditions of growth and development have made adolescence one of the most vital and influential ages for prevention and health promotion, especially in the area of high-risk behaviors. Accordingly, the aim of this study was to determine adolescent health information seeking behavior related to high-risk behaviors in a selected educational district in Isfahan (Iran).MethodologyThe present study was of an applied type, which was conducted using the survey research method. The statistical population consisted of adolescent students at public schools in Isfahan (6519 subjects), and the sample size was determined to be 364 based on Cochran's formula. The sampling method was of a cluster sampling type, and the data collection tool was a researcher-made questionnaire. The validity of the questionnaire was approved by medical librarians, and using the Cronbach's alpha method, the reliability was obtained to be 0.85. SPSS 16 software was used for data analysis at two statistical levels: descriptive and inferential (independent t-test, one-sample t-test, chi-square, Pearson correlation coefficient and Mann-Whitney).Findings"Lack of mobility" was the most important health information need related to adolescent high-risk behaviors. The most important sources to obtain health information related to high-risk behaviors were "the Internet" with a mean score of 3.69 and "virtual social media" with a mean score of 3.49 out of 5. Adolescents had a positive attitude towards health information. The most important barriers to seeking health information were mentioned as follows: "difficulty in determining the quality of information found", "absence of appropriate information", and "concerns about the disclosure of their problems or illness to others". From the perspective of adolescents, the most important criterion for the evaluation of information quality was "the trueness and correctness of the information" and the need for health information related to high-risk behaviors was higher in girls than in boys.Conclusions/SignificanceConsidering adolescents’ positive attitude towards use of health information, it is necessary to put valid information at their disposal through different information resources, taking into account their level of information literacy. Accordingly, medical librarians’ abilities are suggested to be used for the production, evaluation, and introduction of health-related reading materials in the field of high-risk behaviors in easy language and suitable for adolescents.

The Effect of Life Skills Training on Reducing the High-Risk Behaviors among High School Students in Kermanshah, North West of Iran

Background The prevalence of high-risk behaviors in adolescents is one of the most important concerns of the community; this study aimed to determine the effectiveness of life skills training on decreasing high risk behaviors among high school boy students. Materials and Methods In a quasi-experimental study, the statistical population included Mullah Sadra boy high school students in the academic year of 2017-2018. In this research, the sampling was done in two stages; first, to identify the individuals with high-risk behavior questionnaire, was used and 30 students who have high-risk behavior and willing to participate were selected and randomly assigned to intervention group (n=15) and control group (n=15). The educational intervention consisted of 12 sessions (each session was 60-120 minutes). The Life Skillsquestionnaire was completed by two groups before, after and one month after intervention; and data were analyzed using SPSS software version 23.0. Results The mean of pre-test, post-test and follow-up scores in the intervention group for variances of substance abuse, violence, insecure sexual behavior and high-risk behaviors were lower than the control group. But the mean score of life skills in the intervention group was higher than the control group. The results of the analysis of variance showed that the post-test difference of the studied groups (intervention and control) in the components of high risk behaviors in the health area, substance abuse and violence was significant (P<0.05), but in insecure sexual behavior (p=0.766) was not significant. Conclusion According the results, Educational intervention had a positive impact on reducing of high-risk behaviors in boy high school students.

Effectiveness of Neurofeedback on Executive Functions and Tendency Toward High-Risk Behaviors in Adolescents with Attention Deficit Hyperactivity Disorder

Background: Attention deficit hyperactivity disorder (ADHD) is a major neuropsychiatric disorder diagnosis in children and adolescents. Objectives: The current study aimed at evaluating the effectiveness of neurofeedback on executive functions and tendency towards high-risk behaviors in adolescents with ADHD. Patients and Methods: The current quasi-experimental study with pretest-posttest, follow-up, and control group design was conducted on two experimental and control groups of eight ADHD adolescents referred to counseling clinics in Tehran, Iran. The age range of the participants (both the control and experiment groups) was 14 to 18 years. The control group did not receive any treatment and subjects just were given pre-test and post-test. The Conners ADHD rating scales-short self-report, Iranian adolescents risk-taking scale, and Wisconsin card sorting test (WCST) were used in the current study. The Levene, the Shapiro-Wilk, repeated measures, and Bonferroni tests were performed to analyze data with SPSS. Results: Repeated measures showed that intervention had a significant effect on risky behaviors and executive functions of adolescents with ADHD (P < 0.05) and effects of neurofeedback sustained after one month. Conclusions: The findings of the current study showed that neurofeedback can be used to improve the executive functions and to decrease tendency towards high-risk behaviors in adolescents with ADHD.

Correction to: High-Risk Behavior Among Young Adolescents in The Central and Northern Region of Peninsular Malaysia: Baseline Data from The MyHeART Study

The onset of high-risk behaviors in adolescents are associated with family, social and behavioral factors. This study aims to describe the prevalence of high-risk behaviors among young adolescents in Peninsular Malaysia and determine the relationship between high-risk behaviors and family sociodemographics and behaviors. The data utilized are from the Malaysian Health and Adolescents Longitudinal Research Study, a prospective cohort analysis conducted in three large states of Peninsular Malaysia: Selangor, Perak, and the Federal Territory of Kuala Lumpur. The sample included 13-year-old adolescents in their first year of secondary school. Students and parents or guardians were given separate, standardized self-administered questionnaire. A high-risk behavior variable was determined on the basis of exposure to substance use (tobacco, alcohol, and illicit drugs), gambling, and online pornography or violence. The exploratory variable of interest (family sociodemographics) was defined as parents’ demographics, employment status, education level, and socioeconomic status. The analysis included 1341 adolescents and 1146 parents. Of the school-going adolescents, 4.7 % (n = 52) reported HRBs. Tobacco use (9 %, n = 1 19) and watching pornography or violent content on the Internet (5 %, n = 72) accounted for most of the behaviors, whereas illicit drug use contributed the least (2 %, n = 32). More adolescents from the higher socioeconomic groups, than from the middle groups exhibited high-risk behaviors (odds ratio = 3.039, 95 % confidence interval = 2.884–3.202); by contrast, the odds ratio of high-risk behavior among adolescents with a low socio-economic status was 2.246 (95 % CI = 2.014–2.397). Future intervention programs for adolescents should focus on overcoming high-risk behaviors and sustain behavioral changes.