PurposeCurrent literature on prevention and intervention programs for European adolescents who engage in health risk behaviors is limited. Few studies have utilized latent profile analysis methods and internationally comparative data on adolescents and their health risk behaviors, highlighting the need for more comprehensive research using internationally comparative data. The current study aimed to examine the health risk behavior profiles and identify subgroups of adolescents with similar patterns of health risk behaviors using a representative sample of European countries. Findings will inform better targeted prevention strategies for this population. MethodsThe study used a quantitative approach and implemented secondary data analysis using the Health Behavior in School-Aged Children survey 2017/2018 from 43 European countries to understand the prevalence of health risk behaviors among European adolescents and yield latent profiles regarding their health risk behaviors by sex. ResultsFive latent profiles of health risk behaviors were identified for boys and six for girls. For both boys and girls, low-risk (83.4% and 85.7%), poor lifestyle, smoking (6.2% and 5.1%), balanced lifestyle, aggressive acts (5.4% and 3.7%), poor lifestyle, high substance use (2% and 1%), moderate lifestyle, and moderate substance use (3% and 0.9%) were common profiles. A moderate lifestyle and low substance use profile (3.6%) was only specific to girls. DiscussionThe current study provides important insights regarding European adolescents' health risk behaviors. The findings suggest the need for better targeted prevention programming.