Multiple Risk Behaviors Research Articles

A latent class analysis of psychological symptoms and health risk behaviors among Chinese adolescents.

Multiple health risk behaviors (HRBs) tend to co-occur which increase risks of mental disorder. In this study, we identified the association between latent class of HRBs and psychological symptoms in Chinese adolescents. We assessed 22 628 Chinese adolescents from November 2015 to January 2016. The average age of the students were (15.36 ± 1.79), among which there were 10 990 male students and 11 638 female students. A latent class analysis was applied to identity HRBs patterns. The multivariable logistic regression models were utilized to examine the association between HRBs patterns and psychological symptoms. Four latent classes were identified, characterized as low-risk class, moderate-risk class 1 (smoking/ alcohol use (AU)/screen time (ST)), moderate-risk class 2 (unhealthy losing weight (ULW)/ problematic mobile phone use (PMPU)), and high-risk class (ULW/smoking/AU/ST/ PMPU), which were 71.2 %, 3.2 %, 22.3 %, and 3.3 % of involved participants, respectively. Compared to the low-risk class, moderate-risk class 1, moderate-risk class 2, and high-risk class showed that adjusted OR (95 %CI) value of 1.97 (1.68-2.32), 3.98 (3.72-4.26) and 6.38 (CI: 5.47-7.44) were significantly associated with psychological symptoms (P < 0.001 for each). Our findings indicated that identifying different latent class of HRBs would be helpful for the design of tailored interventions, and prevention of different patterns of HRBs should be considered in the implementation of effective intervention programs related to psychological symptoms.

Clustering of multiple health risk behaviours and association with socio-demographic characteristics and psychological distress among adolescents in Ghana: A latent class analysis.

This study examined the prevalence of multiple health risk behaviours, the clustering patterns of health risk behaviours, the association between socio-demographic characteristics, psychological distress and clusters and the relationship between number of health risk behaviours and psychological distress among adolescents in Ghana. Participants were senior high school (SHS) students aged 11–19 years who participated in the 2012 Global School-based Students Health Survey (n = 1763). Five health risk behaviours (smoking tobacco, inadequate fruit intake, inadequate vegetable intake, alcohol intake and physical inactivity) were measured. Participants were classified to be at risk if they indicated they smoked tobacco, did not eat fruit ≥ 2 times a day and vegetables ≥ 5 a day, drank alcohol during the past 30 days and did not engage in physical activity for ≥ 60 min per day during the past 7 days. Latent class analysis and latent regression were used to identify the clusters and factors associated with the clusters respectively. Multiple logistic regression was used to determine the relationship between number of health risk behaviours and psychological distress. The prevalence of multiple health risk behaviours (2 or more) was 94.8%. Two clusters emerged: Cluster 1 (“Poor nutrition, inactive, low substance use cluster”; 91%); Cluster 2 (“High Risk Cluster”; 9%). Using cluster 1 as a reference group, adolescents in the 11–15 years category had lower odds of belonging to cluster 2 (OR = 0.21 CI 0.05–0.91, ρ = 0.036) while those experiencing symptoms of depression had higher odds of belonging to cluster 2 (OR = 2.45 CI 1.45–4.14, ρ = 0.001). No significant relationship was found between number of health risk behaviour and psychological distress. Health risk behaviours cluster among adolescents with age and depression associated with the identified clusters. Early interventions that target these clusters are needed at the individual, school and community level to mitigate the burden of non-communicable diseases.

Single and Multiple Suicide Attempts: Prevalence and Correlates in School-Going Adolescents in Liberia in 2017.

BackgroundThis investigation aimed to estimate the prevalence and correlates of single and multiple suicide attempts among adolescents in Liberia.MethodsCross-sectional nationally representative data were analysed from 2744 adolescents (18 years of median age) who participated in the “2017 Liberia Global School-Based Student Health Survey (GSHS)”.ResultsResults indicate that 33.7% of students had made a suicide attempt in the past 12 months (16.5% single and 17.2% multiple suicide attempts). In adjusted multinomial logistic regression analysis, having no close friends, loneliness, having been frequently physically attacked, ever used amphetamine and fast food intake were associated with multiple suicide attempts in the past 12 months. In addition, having been frequently in a physical fight and current tobacco use were associated with single suicide attempt. In sex stratified analyses, in addition, among boys frequent bullying victimization and among girls, parental tobacco use and parents never or rarely check on home work were associated with multiple suicide attempts. Multiple psychosocial distressors, multiple social-environmental factors, and multiple health risk behaviours were associated with single and multiple suicide attempts.ConclusionOne in three students had made suicide attempt in the past 12 months (one in six students multiple suicide attempts) and several associated variables were detected which can aid in designing intervention strategies.

Abstract PO-010: Clustering of prostate cancer risk behaviors in West African men: The familial cohort study

Abstract Background: The risk of developing prostate cancer (CaP) is higher in Black Africans compared to non-Hispanic whites. Smoking, alcohol consumption, Unhealthy dietary behavior (consumption of high fat, sugar and salt diets) and chronic exposure to pesticides have been strongly associated with the risk of CaP. However, there is scarcity of information on clustering pattern of these risk behaviors among African men. Specific Aim(s)/Methods: Cross-sectional data of 500 West-African Black men representative from the Prostate Cancer Familial Cohort Study was analyzed. Two- step cluster analysis was used to identify cluster groups and multinomial logistic regression analysis was used to determine the association between behavioral risk factors and socio-demographic data. Results: The mean (95% CI) age and years spent in school were 47.93(47.05, 48.82) and 14.11(13.41, 14.80). The prevalence of smoking, alcohol drinking, chronic pesticide exposure and unhealthy diet was 26.2%, 44.7%, 39.0% and 82.4% respectively. Men of ages 35-34 years consumed High fat, sugar and salt (HFSS) diet most frequently. Most (96.6%) of the respondents were involved in at least one CaP risk behavior. Eleven clusters were identified in the clustering analysis, 3.4% had no risk, 24.4% had single risk behavior, 48.8% had double risk behaviors and 23.4% had multiple risk behaviors. Men with uncompleted college education were more likely to have multiple risk behaviors. Nigerian men were more likely to smoke or consume alcohol in addition to HFSS dietary intake. Men with Chronic exposure to pesticide consuming HFSS diet and/or smoking were more likely to have low body mass index. Cameroon men were more likely to have chronic exposure to pesticide in addition to HFSS diet intake and/or smoking. Conclusion: Policies and Behavior change interventions focused on double and multiple risk behaviors for CaP with consideration for socio-demoographic differences is essential for reducing the risk of CaP in Black men. Citation Format: Oluwafunke Akinbule, Catherine Oladoyinbo, Opeyemi Bolajoko. Clustering of prostate cancer risk behaviors in West African men: The familial cohort study [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-010.

Drug use characteristics and correlates of multiple risk behaviors among synthetic drug users

ABSTRACT Objective: Understanding drug use characteristics can help inform preventive education and behavioral therapy. The aims of the current study are to describe drug use characteristics and examine factors associated with multiple risk behaviors among synthetic drug users in China. Method: Cross-sectional data were obtained in 2015 from 846 (457 men and 389 women) adult synthetic drug users in China. SAS 9.4 was used for all data analyses. Results: Multiple regression analyses showed that female participants were more likely to have engaged in a suicide attempt, while male participants were more likely to have engaged in group sex under the influence of drugs, gambling, vandalism, beating up others, motorcycle racing, and other criminal activities. Moreover, age, occupation, education level, household socioeconomic status, age of drug initiation, and drug use frequency were associated with multiple risk behaviors. Conclusions: Future health promotion efforts to reduce risk behaviors among synthetic drug users need to focus on reducing drug use frequency and helping them find possible ways to improve livelihoods. The gender differences in risk behaviors also suggest the needs of gender-specific prevention intervention strategies such as mental health services and reduction of partner influence among female users, and reduction of peer influence among male users.

Prevalence and Correlates of Sexual Risk Behavior among School-Going Adolescents in Four Caribbean Countries.

This study aimed to assess the prevalence and correlates of sexual risk behaviors among adolescents in the Caribbean. Nationally representative cross-sectional data were analyzed from 9143 adolescents (15 years = median age) that took part in the 2016 Dominican Republic, 2016 Suriname, 2017 Jamaica, and 2017 Trinidad and Tobago Global School-Based Student Health Survey (GSHS). The results indicate that 41.4% of the students had ever had sex, ranging from 26.4% in Trinidad and Tobago to 48.1% in Jamaica. Among the sexually active, 58.8% had had ≥2 sexual partners; 58.6% had had an early sexual debut (≤14 years); 41.9% had not used birth control the last time they had sex; 28.4% had not used a condom the last time they had sex; and, of the whole sample, 31.9% had engaged in two or more (multiple) sexual risk behaviors, ranging from 16.5% in Trinidad and Tobago to 40.3% in Jamaica. In an adjusted logistic regression analysis, substance use (tobacco, alcohol, and cannabis), psychological distress, frequent soft drink intake, participation in physical fighting, school truancy, older age, and male sex were associated with single and/or multiple sexual risk behaviors. A large number of adolescents in the Caribbean reported sexual risk behaviors, emphasizing the need for intervention.

E-cigarette use and concurrent risk behaviors among adolescents

PurposeAlthough electronic cigarette (e-cigarette) use is on the rise among adolescents, its relationship with risk behaviors is unclear. This study aimed to examine whether e-cigarette use was related to other risk behaviors and whether age and sex play a role in those associations. MethodsData from the 2017 Youth Risk Behavior Surveillance System was used. Weighted logistic regression analysis was conducted to examine the relationships among variables of interest. FundingsThe results showed that e-cigarette users, compared to nonusers, had higher odds of using other types of substances, as well as being involved in other risk behaviors including driving-related behaviors, sexual activity-related behaviors, and violence-related behaviors. Furthermore, some of these relationships are moderated by age and sex. DiscussionOur findings suggest that e-cigarette use is linked to other risk behaviors among adolescents. Policy makers and educators should address multiple risk behaviors as part of comprehensive tobacco-free policies and youth substance use prevention programs.

Beach boys in Galle, Sri Lanka: multiple HIV risk behaviours and potential for HIV bridging

BackgroundThere are limited data globally on HIV in men who engage in casual and transactional sex with female tourists.MethodsIn 2018 we carried out a respondent-driven sampling (RDS) survey among beach boys in Galle, Sri Lanka, to determine prevalence of HIV and other infections, HIV risk behaviours and utilisation of HIV prevention services. Eligibility criteria included men who cruise in and around beach areas and who had anal and/or vaginal sex with female or male tourists in the 12 months before the survey.ResultsWe recruited 373 beach boys. Approximately 49.6% of the participants were married, while 45.7% were single and 4.7% divorced, separated or widowed. A lower percentage of beach boys reported regular partners in the past 12 months (52.3%) compared to casual partners (95.4%). Condom use at last sex with a casual partner was higher (76.7%) compared to condom use with regular partners (58.3%). Condom use at last sex with a tourist was reported by 75.3%. Ever receiving money, goods or services in exchange for sex was reported by 39.7%. For 85.5% of beach boys who sold sex, the last paying partner was a tourist (85.5%) and a woman (82.0%). In the past 12 months before the survey, 32.3% of beach boys paid money for sex, and 99.5% did so from women.Ever been tested for HIV was reported by 35.3, and 69.1% of those were tested in the 6 months before the survey. In the adjusted multivariate analysis, significant correlates of never testing for HIV were lack of comprehensive knowledge about HIV and unprotected last sexual intercourse with tourists.The prevalent infections were: HIV, 0.3% (95% CI 0.0–0.4%); syphilis, 0.5% (0.0–1.2%); herpes virus type-2, 5.0% (2.5–7.5%).ConclusionsThere are low level HIV and syphilis prevalence among beach boys in Galle but a high level of sexual risk taking. Beach boys may be acting as a bridge for HIV transmission between higher-risk groups (paying female tourists, men who have sex with men) and lower-risk heterosexual female population in Sri Lanka. More research is needed in South-East Asia on men who trade sexual services to female and male tourists.

Multiple risk behaviour and socioeconomic status during the transition from adolescence to adulthood

Abstract Background Multiple risk behaviour (MRB) means the occurrence of two or more risk behaviours and is associated with a range of negative outcomes. What is unknown is whether MRB is associated with socioeconomic status (SES) in adulthood. This study aimed to examine the association between adolescent MRB and young adult SES and whether those who experienced early life socioeconomic disadvantage also faced greater negative impact of adolescent MRB. Methods Two prospective birth cohort studies; British Cohort Study 1970 (BCS70) and Avon Longitudinal Study of Parents and Children (ALSPAC), born in 1991-1992, were used. Logistic regression assessed the association between MRB and young adult SES. Three early life SES variables were examined for their moderating effect on the association using models with and without interaction parameters. Likelihood ratio tests ≤p=0.05 indicated evidence to support moderation. Multiple imputation was used to account for missing data. Results Adolescent MRB was negatively associated with young adult SES (university degree attainment) in BCS70 (OR 0.81, 95% CI: 0.76, 0.86) and ALSPAC (OR 0.85, 95% CI: 0.82, 0.88). There was a dose response, with each additional risk behaviour resulting in reduced odds of university degree attainment. In BCS70, maternal education (p = 0.03), parental occupation (p = 0.009) and household income (p = 0.03) moderated the effect of adolescent MRB on young adult SES. The effect of MRB on university degree attainment was stronger for those from poorer socioeconomic backgrounds. No evidence of moderation was found in ALSPAC. Conclusions Adolescence is a critical time to address MRB as behaviours established here may have effects in adulthood. Intervening on adolescent MRB may improve later SES and thus health outcomes later in life. Evidence for a moderation effect in the BCS70 but not ALSPAC suggests that measures should be investigated for their ability to capture the nuance of contemporary young adult SES. Key messages Intervening on adolescent multiple risk behaviour could improve socioeconomic life chances in young adulthood. Variables that capture the nuance of contemporary young adult socioeconomic status should be explored.

Prevalence and correlates of multiple behavioural risk factors of non-communicable diseases among university students from 24 countries.

Globally non-communicable diseases (NCDs) are on the increase. The goal of the study was to estimate the prevalence and correlates of multiple behavioural risk factors of NCDs among university students from 24 countries. In a cross-sectional study, the sample included 18 017 university students from countries in Africa, the Americas and Asia. indicate that prevalence of single behavioural NCD risk indicators were 38.2% for physical inactivity, 80.5% for inadequate fruit and vegetables intake, 23.1% for having overweight/obesity, 10.5% for heavy alcohol use and 11.8% for current tobacco use. Students had on average 1.6 (SD=0.9), and 15.9% had three or more behavioural NCD risk factors. In adjusted linear regression, male sex was positively and stronger beliefs in health benefits were negatively associated with multiple behavioural NCD risk factors. A high prevalence and co-occurrence of behavioural risk factors of NCDs was discovered. Several behavioural NCD risk factors, such as male sex and low health behaviour benefits beliefs, were found that could be utilized in targeted interventions.

Living with a Smoker and Multiple Health-Risk Behaviors.

Behavioral medicine is showing growing theoretical and applied interest in multiple health-risk behaviors. Compared to engaging in a single health-risk behavior, multiple health-risk behaviors are linked to increased morbidity and mortality. A contextual determinant of multiple risk behaviors may be living with a smoker. This study investigated the role of living with a smoker in predicting multiple health-risk behaviors compared to a single health-risk behavior, as well as whether these multiple risk behaviors occur across both physical activity and dietary domains. Moreover, the study tested these effects across 3 years in longitudinal and prospective (controlling for health-risk behaviors at baseline) analyses. Participants were 82,644 women (age M = 63.5, standard deviation = 7.36, age range = 49-81) from the Women's Health Initiative Observational Study. Analyses used multinomial and binary logistic regression. Living with a smoker was more strongly associated with multiple health-risk behaviors than with a single health-risk behavior. These multiple risk behaviors occurred across both physical activity and dietary domains. The effects persisted across 3 years in longitudinal and prospective analyses. Living with a smoker, compared to not living with a smoker, increased the odds of multiple health-risk behaviors 82% cross-sectionally and, across 3 years, 94% longitudinally and 57% prospectively. These findings integrate research on multiple health-risk behaviors and on living with a smoker and underscore an unrecognized public health risk of tobacco smoking. These results are relevant to household-level interventions integrating smoking-prevention and obesity-prevention efforts.

The Impact of Smoking and Multiple Health Behaviors on All-Cause Mortality

Four common health risk behaviors have the greatest impact on all-cause mortality risk, but studies are needed with larger samples and the appropriate age range for cigarette smokers. We examined the impact of smoking in the context of multiple health behaviors on all-cause mortality using a nationally representative sample of adults aged 30 and older in the United States. National Health Interview Survey data from 1997 to 2005 were linked to the National Death Index with a follow-up to December 2015. The primary dependent variable was all-cause mortality, and the primary predictors were smoking, heavy drinking, physical inactivity, and unhealthy weight (underweight or obesity). The sample contained 189,087 individuals (≥ age 30; population estimate = 140.7 million). Our primary statistical analysis tool involved fitting Cox proportional hazards models. Our findings demonstrated that smoking led to the highest mortality risk among the four risk behaviors examined, but more than half of smokers engaged in at least one additional health risk behavior. Smokers who engaged in multiple health behaviors experienced higher increased mortality risks: smoking combined with one other health risk behavior increased mortality risk by 32% and by 82% when combined with two behaviors. Engaging in all four risk behaviors more than doubled the mortality risk of smokers. Smoking cessation interventions that address multiple risk behaviors—physical inactivity, heavy drinking, and unhealthy weight—will likely prevent premature death better than interventions that address only smoking.

Effect and efficacy of lifestyle interventions as secondary prevention.

IntroductionImprovements in health behaviour are often recommended as part of secondary prevention in patients with stroke and transient ischaemic attack. However, there is a lack of knowledge as to how this is applied in clinical practice.AimIn this systematic review and meta‐analysis, we examined the effect of counselling or educational intervention directed at individual or multiple behavioural risk factors on blood pressure and other reported outcomes.MethodsPubMed, Embase, PsycInfo, CINAHL, Scopus and Web of Science were systematically searched. Meta‐analyses were conducted on all outcome measures if appropriate. A qualitative analysis of the content of the interventions was conducted to review which elements the interventions consisted of.ResultsTwenty‐nine randomized controlled trials were identified. Fourteen reported effects on systolic blood pressure, and pooled results showed a significant beneficial effect (n = 2,222; −3.85 mmHg [95%CI −6.43; −1.28]). The effect was greatest in the four interventions which included supervised training (n = 174; −9.83 mmHg [95%CI −16.56; −3.09]).ConclusionModifying health behaviour in stroke survivors might have a moderate beneficial effect on blood pressure, especially if the intervention includes supervised physical training.

A longitudinal study of multiple lifestyle health risk behaviours among nursing students and non-nursing peers.

The aim of this paper is to compare the evolution of health risk behaviours between undergraduate nursing and social work students. Nursing includes the promotion of health and the shaping of healthy behaviours. An important determinant for providing lifestyle advice is the lifestyle of nurses themselves. Longitudinal comparative study. We compared lifestyle risk behaviours (binge drinking, cannabis/hashish/marijuana use, smoking, oral hygiene/toothbrushing, breakfast/fruit/vegetable consumption, physical activity and screen time/sedentary behaviours) using a self-administered standardized questionnaire in nursing (n = 121) and social work (n = 140) students at the beginning (2012) and the end of their studies (2015). Adjusted multivariable logistic/Poisson regression models were performed. There were no statistically significant differences between the departments in most risk factors in both assessments. However, in relation to their first year, both nursing and social work students displayed higher relative risk of engaging in more behavioural risk factors at the end of their studies (in delivery/junk food consumption, sunburns, hashish/marijuana use and multiple sexual partners). Social work students displayed better behaviours in physical activity and breakfast intake. Nursing students share the patterns of their nonnursing peers in behavioural risk factors compromising their future health and health-promoting role. We need strategies to safeguard the professional nursing practice.

Study protocol of the Health4Life initiative: a cluster randomised controlled trial of an eHealth school-based program targeting multiple lifestyle risk behaviours among young Australians

IntroductionLifestyle risk behaviours, including alcohol use, smoking, poor diet, physical inactivity, poor sleep (duration and/or quality) and sedentary recreational screen time (‘the Big 6’), are strong determinants of chronic disease....

Tobacco use and associated health risk behaviours among university students in 27 countries.

Evidence of the relationship between tobacco use and multiple health risk behaviours is limited. The study aimed to investigate the relationship between tobacco use and health risk behaviours in university students across different cultures. In a cross-sectional study the sample included 23,396 university students from 27 countries in Africa, Asia and the Americas. Indicate that 5.8 and 5.5% were daily and not daily tobacco users, respectively. In adjusted logistic regression analysis, less than daily and/or daily tobacco use was associated with nutrition and dietary risk behaviour (overweight or obesity, high sodium consumption, rarely or never having breakfast and not avoiding fat and cholesterol), addictive behaviour (binge drinking, drug use, and gambling), sleep risk behaviours (long sleep, poor sleep quality and restless sleep) and other health risk behaviour (having been in a physical fight, inadequate tooth brushing, and multiple sexual partners in the past year). Compared to non-tobacco users, less than daily and/or daily tobacco users had significantly higher overweight or obesity, dietary risk behaviour, addictive behaviour, sleep risk behaviours and other health risk behaviour. These associations may be taken into account in health promotion strategies targeting multiple health compromising behaviours.

Health risk behaviour is associated with psychological distress among school-going adolescents in five association of Southeast Asian Nations (ASEAN) countries.

This investigation aimed to study associations between multiple health risk behaviour and psychological distress among in-school adolescents in five association of Southeast Asian Nations (ASEAN) countries. Cross-sectional data from the 2015 "Global School-based Health Survey (GSHS)" included 33,184 students (mean age 14.3 years, standard deviation (SD)=1.6 years) that were representative of all students in middle school students in Indonesia, Laos, Philippines, Thailand and Timor-Leste. The mean prevalence of health risk behaviours was 3.1 (SD=1.2) (range 0-8), and the prevalence of single psychological distress was 14.6% and multiple psychological distress 8.6%. In adjusted multinomial logistic regression analysis, engaging in a greater number of health risk behaviours, being female, older age, food insecurity (experience of hunger) were positively and parental or guardian support and school attendance were negatively associated with both single and multiple psychological distress. This study confirms that the co-occurrence of multiple health risk behaviours is associated with psychological distress among adolescents, which should be considered when designing intervention programmes in this population.

Sexual risk behaviour and its correlates among adolescents in Indonesia, Laos, Thailand and Timor-Leste: results from national school surveys in 2015.

The study aimed to assess the prevalence and correlates of sexual risk behaviours among adolescents in four Southeast Asian countries. In the cross-sectional "Global School-Based Student Health Survey (GSHS)", 24,423 adolescents (mean age 14.1 years, SD=1.7) from Indonesia, Laos, Thailand and Timor-Leste responded to a questionnaire in 2015. Overall, 8.5% of the students (11.0% males and 6.3% females) ever had sex, ranging from 5.3% in Indonesia to 26.4% in Timor-Leste. Among the sexually active, 49.3% (55.9% males and 36.8% females) had their first sexual intercourse before the age 14 years, ranging from 16.1% in Laos to 73.9% in Indonesia, 59.7% (62.6% males and 53.5% females) had multiple sexual partners, ranging from 55.5% in Timor-Leste to 63.4% in Indonesia, 46.9% (46.8% males and 46.5% females) did not use a condom at last sex, ranging from 37.0% in Thailand to 65.3% in Indonesia, 49.8% (53.7% males and 43.7% females) had not used or did not know of the use of birth control at last sex, ranging from 40.6% in Thailand to 61.5% in Timor-Leste, and 54.2% (54.9% males and 47.0% females) engaged in multiple sexual risk behaviour, ranging from 45.9% in Laos to 78.0% in Indonesia. In adjusted logistic regression analysis, male sex, older age, food insecurity, tobacco use, alcohol use, ever cannabis and/or amphetamine use, psychological distress, and school truancy were associated with two or more and/or multiple sexual risk behaviours. A high proportion of students engaged in various sexual risk behaviours calling for a scale up comprehensive sexuality education and integration of substance use and mental health into such intervention programmes in this adolescent school population.

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

Exploring health-risk behaviors related to road safety and car drifting among adolescents in Saudi Arabia: the co-occurrence of multiple risk behaviors.

Adolescence is a fundamental stage of life where they go through huge changes and development. As a result, they are more likely to engage in behaviors that may jeopardize their life and health. The main objectives of this paper is to investigate risky-behaviors related to road traffic safety and dangerious car drifting among adolescents in Saudi Arabia. This was a school-based cross-sectional study conducted among male school adolescents in Riyadh, Saudi Arabia. A multi-stage probability sampling technique was performed to recruit the participants. A total of 1,501 male adolescents were included in this study, studying in private and public high schools. A total of 78.7% of the students were found to be driving cars, which indicated that a high proportion of adolescents drive without a license. A total of 96% and 97.7% of adolescents do not use seat belt when driving nor when riding a vehicle as a passenger, respectively. Using helmet was a very rare practice among adolescents since only 1.4% and 2.0% wore a helmet when using non-motorized and motorized vehicles, respectively. Attending car drifting events, joining people while performing car drifting and actual performing car drifting were prevalent as 46.7%, 42.9%, 36.1%, respectively. About 58% of the adolescents reported not been taught about how to avoid traffic accidents, and 80% reported the need for more health education regarding traffic safety. The logistic regression analysis indicates adolescents car drifting was independently associated with adolescents' age (OR=1.2; 95%CI=1.1-1.3; p <0.01), studying in private schools (OR=1.2; 95%CI=1.2-2.0; p≤0.015), being Saudi (OR=2.5; 95%CI=1.9-2.8; p <0.001), do not like schools (OR=1.7; 95%CI=1.4-2.4; p <0.001) and poor academic performance (OR=1.7; 95%CI=1.3-2.3; p<0.001). Also, the adjusted logistic regression confirmed that car drifting was independently associated with several health risk behaviors including joining people performing car drifting, attending car drifting events, not brushing teeth, smoking behavior, want to use drugs, carrying weapons, and taking part in bullying others. Large proportions of adolescents engage in multiple risky road traffic behaviors. Therefore, it is strongly advisable for policymakers and other stakeholders to devise national strategies that consider road safety and risky driving behaviors among adolescents and school students. This study calls for a strategic intervention plan to change the culture of risky driving through a structured and comprehensive curriculum in school settings.