Patterns 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.

Exploring associations of adverse childhood experiences with patterns of 11 health risk behaviors in Chinese adolescents: focus on gender differences

PurposeAdolescents exposed to adverse childhood experiences (ACEs) are at increased risk for health-compromising behaviors. However, few studies have investigated how ACEs correlate with patterns of health risk behaviors (HRBs) during adolescence, a crucial developmental period. The aim was to extend the current knowledge about the relationship between ACEs and HRB patterns among adolescents, and to explore gender differences.MethodsA multi-centered population-based survey was conducted in 24 middle schools in three provinces across China between 2020 and 2021. A total of 16,853 adolescents effectively completed anonymous questionnaires covering exposure to eight ACE categories and 11 HRBs. Clusters were identified using latent class analysis. Logistic regression models were utilized to test the association between them.ResultsThere were four classes of HRB patterns: “Low all” (58.35%), “Unhealthy lifestyle” (18.23%), “Self-harm” (18.42%), and “High all” (5.0%). There were significant differences between HRB patterns in terms of the different numbers and types of ACEs in three logistic regression models. Specifically, compared to “Low all,” different types of ACEs were positively associated with the three other HRB patterns, and there were significant trends toward increase in the three latent classes of HRBs with higher ACEs. In general, females with ACEs had a higher risk of “High all” except sexual abuse than males.ConclusionOur study comprehensively considers the association between ACEs and aggregation categories of HRBs. The results support efforts to improve clinical healthcare, and future work may explore protective factors based on individual, family, and peer education to mitigate the negative trajectory of ACEs.

Association of Weight Perception, Body Satisfaction, and Weight Loss Intention With Patterns of Health Risk Behaviors in Adolescents With Overweight and Obesity

Obesity is a public health issue and childhood is a critical window in which to establish healthy eating patterns and modify risk factors for overweight. This study aims to verify the association of weight perception, body satisfaction, and weight loss intention with patterns of health risk behaviors in adolescents with overweight and obesity. We analyzed health risk behavior from a school-based national survey conducted in 2015 in Brazil (n = 2,703 students with overweight or obesity, aged 13–17 years). We performed latent class analysis of alcohol consumption, tobacco use, physical activity, screen time, and eating habits for adolescents with overweight and identified four distinct health behavior patterns. The association of these patterns with weight perception, body satisfaction, and weight loss intention was analyzed through multinomial logistic regression. Adolescents who perceived themselves as “fat” or “very fat” were more likely to have a sedentary lifestyle and low consumption of fruit and vegetables. Body satisfaction was a protective factor against sedentary lifestyle. Students who reported weight loss intention were less likely to be in high–health-risk behavior groups (low consumption of fruit and vegetables; sedentary lifestyle; tobacco and alcohol use). Self-perception as overweight had detrimental associations, while body satisfaction was a protective factor for a healthy lifestyle. Weight loss intention still requires rigorous analysis due to inconsistencies in the literature. The complexity of the relationship between body image and obesity needs to be highlighted. Multicomponent strategies are required to control the global obesity pandemic.

The Longitudinal Association Between Exposure to Violence and Patterns of Health Risk Behaviors Among African American Youth.

We investigate whether exposure to violence (ETV) during adolescence and emerging adulthood predicts engagement in chronic disease-related health risk behaviors years later among African Americans. A longitudinal study following youth from mid-adolescence (mean age = 14.8 years) to young adulthood (mean age = 32.0 years). Flint, Michigan. Four hundred forty-two African American (96.2%) and mixed African American and White (3.8%) participants. Outcomes were diet, smoking, drinking, and physical inactivity. Covariates were ETV, sex, mother's educational attainment, and substance use by siblings, peers, and parents. Latent profile analysis was conducted to identify distinct patterns of adult health risk behaviors and assess the association of youth ETV and identified patterns. Four latent profiles were identified: high substance use (n = 46; 10.41%), high overall risk (n = 71; 16.06%), low overall risk (n = 140; 31.67%) and inactive (n = 185, 41.86%). Relative to the low overall risk profile, ETV was associated with being in the high overall risk profile (b = 0.37, p = 0.04), but not other profiles. Female gender and higher maternal education were associated with being in the inactive profile compared to the low overall risk profile. Peer alcohol and tobacco use were associated with being in the high substance use profile. ETV during adolescence and emerging adulthood increased the risk of engagement in multiple health risk behaviors later in life.

Latent Class Analysis of Multiple Health Risk Behaviors among Australian University Students and Associations with Psychological Distress.

University students have high rates of health risk behaviors and psychological distress. This study explores patterns of health behaviors among a sample of Australian university students, and determines whether patterns of health behaviors are associated with psychological distress and demographic characteristics. Cross-sectional data from the University of Newcastle Student Healthy Lifestyle Survey 2019 were analyzed. Fruit and vegetable intake, sugar-sweetened beverage intake, physical activity, sitting time, smoking, alcohol intake, drug use, sleep and psychological distress were assessed. Latent class analysis (LCA) was used to identify patterns of health risk behaviors, and latent class regression to explore associations between psychological distress and demographic characteristics with health behavior classes. Analysis included 1965 students (mean age 25.8 ± 8.6 years, 70.7% female). Three patterns of health behaviors were identified: healthier (48.6%), moderate (40.2%) and unhealthy (11.2%) lifestyle classes. Students in the moderate and unhealthy lifestyle classes had higher odds of moderate (OR 1.43 and 2.37) and high/very high psychological distress risk (OR 2.71 and 11.69). Students in the unhealthy and moderate lifestyle classes had a higher odds of being male, younger, enrolled in transition to university and English language courses, Aboriginal or Torres Strait Islander descent and to report some financial difficulty. Study findings may be used to inform the design of mental health interventions for university students that target key health risk behaviors.

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 behaviors and its association with diabetes in a Southern Chinese adult population: a cross-sectional study.

BackgroundIdentifying the clustering patterns of health risk behaviors (HRBs) within individuals and their health impacts are essential to develop lifestyle promotion strategies. This study aimed to explore the clustering of a range of HRBs and the associations between such identified clusters and diabetes in Southern Chinese adults.MethodsData from 5,734 adults aged 35–75 years and underwent health examinations from November 2012 to December 2013 at a tertiary hospital in Guangzhou were analyzed. Behavioral characteristics, including smoking, alcohol use, physical activity, and sleep duration and quality, were measured by questionnaires. Latent class analysis was conducted by gender to identify HRBs clustering patterns, and logistic regression models were used to estimate the associations between behavioral patterns and diabetes.ResultsThree distinct behavioral clusters emerged in both genders. Male classes were defined as: (1) healthy lifestyle (Class 1, 62.9%); (2) cumulate harmful habits (Class 2, 27.1%); (3) poor sleep and risky habits (Class 3, 10.0%). Female classes were: (1) healthy lifestyle (Class 1, 83.0%); (2) inactive, daytime dysfunction (Class 2, 5.7%); (3) poor sleep habits (Class 3, 11.3%). Individuals of Class 2 and Class 3 showed a higher likelihood of diabetes across genders (multivariable-adjusted ORs [95% CIs], 2.03 [1.49–2.76] and 2.61 [1.78–3.81] among males, 2.64 [1.16–5.98] and 1.81 [1.07–3.06] among females) when compared with those of Class 1.ConclusionsOur data provided additional evidence of HRBs clustering among adults, and such clustering was associated with an increased risk of diabetes. These findings have implications for identifying vulnerable subgroups and developing diabetes prevention programs.

Heterogeneity of adolescent health risk behaviors in rural western China: A latent class analysis.

BackgroundAdolescent health risk behaviors are a public health priority given their prevalence and their associations with chronic diseases and life quality in adulthood. This study examined the heterogeneity of adolescent health risk behaviors and the associations between demographic characteristics and subgroup membership in rural western China.MethodsIn fall 2015, 2805 students from rural middle schools in Sichuan Province were surveyed using the Health-Related Behavior Questionnaire for Adolescents. Latent class analysis (LCA) was used to identify subgroups of adolescents with distinct patterns of health risk behaviors. Differences in class membership related to selected demographic characteristics were examined using multinomial logistic regression analysis.ResultsA four-class model emerged: (1) high-risk group (n = 108, 4.0%), (2) high-physical-inactivity and suicide-risk group (n = 340, 12.1%), (3) moderate-risk group (n = 897, 32.0%), and (4) low-risk group (n = 1460, 52.1%). The multinomial logistic regression analysis revealed that boys and adolescents with poor parental relationships and high allowances (spending money) were significantly more likely to be in the high-risk group than the low-risk group.ConclusionsAdolescents in rural western China are a heterogeneous population requiring different tailored and effective interventions.

Perceived peer norms, health risk behaviors, and clustering of risk behaviors among Palestinian youth.

Relatively little is known about patterns of health risk behaviors among Middle Eastern youth, including how these behaviors are related to perceived peer norms. In a sample of approximately 2,500 15–24 year old Palestinian youth, perceived engagement of general peers in alcohol consumption, drug use and sexual activity was substantially greater than youths’ own (self-reported) engagement in these activities, suggesting a tendency to overestimate the prevalence of risk-taking behavior among peers. Individual participation in a risk behavior strongly covaries with the perceived levels of both friends’ and peers’ engagement in that behavior (p = 0.00 in each case). In addition, significant clustering of risk behaviors is found: youth who participate in one risk behavior are more likely to participate in others. These findings for a rare representative sample of Middle Eastern youth are strikingly similar to those in the US and Europe. The clustering of behaviors suggests that prevention programs should be structured to deal with a range of connected risk behaviors for which certain youth may be at risk. The findings also suggest that adjusting expectations about peers’ behavior may reduce young Palestinians’ engagement in risk taking.

Health-Risk Behavior Profiles and Reciprocal Relations With Depressive Symptoms From Adolescence to Young Adulthood

PurposeWe examined co-occurrences of multiple health-risk behaviors among adolescents in a 5-year longitudinal design as well as their associations with mental health outcomes. MethodsLatent transition analyses explored subgroups of adolescents (N = 229; 51% males) who engaged in distinct patterns of health-risk behaviors and transitions over time. Moreover, longitudinal relations between risk behavior profiles and depressive symptoms were also explored. ResultsWe identified four latent profiles based on risk levels of safety and violence, sexual behavior, alcohol use, and marijuana and other drug use at both 18 years and 23 years: low risk, modest risk, medium risk, and high risk. Some adolescents maintained their latent profile membership over time, but more transitioned between risk profiles. Adolescents with more depressive symptoms had a higher probability of developing into the high-risk versus low-risk and modest risk profiles at 23 years. Adolescents in the high-risk, low-risk, and modest risk profiles at 18 years developed more depressive symptoms in young adulthood compared with medium risk adolescents. ConclusionsThis study provides a better understanding of the prevalence, distribution, and change patterns of health-risk profiles across adolescence and young adulthood in a European American sample. Reciprocal relations between high-risk profiles and depressive symptoms suggest the need for integrated but tailored prevention and intervention programs.

Prevalence and Patterns of Health Risk Behaviors of Palestinian Youth: Findings from a Representative Survey

Prevalence and Patterns of Health Risk Behaviors of Palestinian Youth: Findings from a Representative Survey

Patterns of Health-Risk Behaviors among Jordanian Adolescent Students

Little information exists about health-risk behaviors in Jordanian adolescents especially among 15 - 19 years olds. The purpose of this study was to assess the patterns of three of health-risk behaviors, namely, diet, physical activity, and tobacco use of the Jordanian adolescent students aged 15 to 19 years old, and to compare the patterns of these behaviors between male and female adolescents. A descriptive cross-sectional design was used. A multi-stage stratified random sample was obtained from the public school educational directorate, which is affiliated to Amman governorate. A random sub sample of eight public comprehensive secondary schools was selected, four schools for females and four schools for males. A total of 750 students (375 boys and 375 girls), their ages between 15 - 19 years were included in the analysis. Data were collected by using two tools: students’ profile structured questionnaire (tool 1), and a modified version of the General School Health Survey questionnaire (tool 2). The findings of this study showed that 10.7% of students were overweight and 4.9% were obese. The majority of students had eaten less than the daily requirements of fruits, vegetables, and milk daily, while the intake of soft drinks was higher than recommended. One-fifth of students had been physically active at least 60 minutes daily. Overall, (55.5%) had tried smoking and 44.0% had smoked any other form of tobacco such as water pipe. Moreover, 62.4% had tried to quit smoking cigarettes. Furthermore, there were significant differences between males and females regarding these risk behaviors. In conclusion, there are problems with Jordanian adolescents relating to diet, physical activity, and tobacco use. The results highlight the need for effective school health program that combines education, counseling and behavioral skill building along with environmental support to enhance students’ efforts, intentions, and strategies to overcome these risk behaviors. In addition, the findings could help policy makers to strength strategies and policies to maintain healthy adolescents and schools.

Sexual coercion and health-risk behaviors among urban Chinese high school students

Objective To determine the association between health-risk behaviors and a history of sexual coercion among urban Chinese high school students. Design A cross-sectional study was performed among 109,754 high school students who participated in the 2005 Chinese Youth Risk Behavior Survey. Data were analyzed for 5,215 students who had experienced sexual intercourse (1,483 girls, 3,732 boys). Multivariate logistic regression was used to determine the relationship between sexual coercion and the related covariates, and data were stratified by gender. Results Of those students who had had sexual intercourse, 40.9% of the females and 29.6% of the males experienced sexual coercion (p<0.01). When analyses controlled for demographic characteristics, in the study sample, that is, students who had sexual intercourse, drug use (odds ratios [OR], 2.44), attempted suicide (OR, 2.30), physical abuse (OR, 1.74), binge drinking (OR, 1.62), verbal abuse (OR, 1.29), experience of being drunk (OR, 0.68), and smoking of cigarettes (OR, 0.52) were related to a history of sexual coercion. Patterns of health-risk behaviors also differed among female and male students who had experienced sexual coercion. Conclusions Sexual coercion is associated with health-risk behaviors. Initiatives to reduce the harm associated with sexual coercion among high school students are needed.

Agregação de fatores de risco para doenças e agravos crônicos não transmissíveis em adultos de Florianópolis, SC

To investigate clustering patterns of health risk behaviors for non communicable diseases and its associated factors. a Random telephone survey with 1,996 adults from Florianopolis, SC, was conducted in 2005. Tobacco use, high alcoholic intake episodes, fruit consumption and physical inactivity were investigated. Clustering was examined by the ratio between observed and expected prevalence of each of the 16 possible combinations. These clustered risk factors comprised the main outcome and binomial and multinomial logistic regression was conducted to examine socio-demographic correlates. 43% of men and 36.6% of women clustered at least two health risk factors. Three (19.2%; CI 95% 16.7 - 21.7) and five (9.8%; CI 95% 8.0 - 11.6) specific combinations exceed the expected prevalence, respectively, in men and women. Women with low schooling level and older were more likely to cluster health risk behaviors. although men showed higher prevalence of single health risk behavior and its combinations, women presented more specific combinations that clustered above the expected. Knowledge on the clustering pattern of these health risk behaviors may guide the design of more effective health promotion initiatives.

Resilience and patterns of health risk behaviors in California adolescents

Objectives Assess whether adolescent health risk behaviors cluster, and whether resiliency factors are associated with observed clusters. Methods The cross-sectional population-weighted 2003 California Health Interview Survey was used ( N = 4010). Four gender-specific clusters were based on smoking, alcohol use, low fruit/vegetables consumption, and physical inactivity. Resiliency factors included parental supervision, parental support, role model presence and adolescent mental health. Conditional regression was used to measure the association of individual health risk behaviors and clusters with resiliency factors. Results Health risk behaviors clustered as follows: “Salutary Adherents” (no reported health risk behaviors), “Active Snackers” (physically active, low fruit/vegetable consumers), “Sedentary Snackers” (physically inactive, low fruit/vegetable consumers), and “Risk Takers” (smokers, alcohol users, many also physically inactive and low fruit/vegetable consumers). Greater parental supervision was associated with lower odds of being in unhealthful clusters. Among males, having greater parental support reduced odds of being an “Active Snacker” or “Sedentary Snacker.” Among females, role model presence reduced odds of being in unhealthful clusters, while depressiveness increased the odds. Conclusions Health promoting interventions should address multiple health risk behaviors in an integrated fashion. Gender-specific, ethnically-targeted, family-centered strategies that address parenting, particularly parental supervision would be useful. Addressing depressiveness may be especially important for female adolescents.

Within-state geographic patterns of health insurance coverage and health risk factors in the United States

Background: A number of health risk factors have been associated with the incidence and mortality of common diseases. Although knowing risk factor patterns at a small-area level would be useful for ecologic analyses and prevention program planning, risk factor data are generally published only at the state or regional level in the United States. This study presents maps of within-state patterns of several such factors. Methods: Responses to Behavioral Risk Factor Surveillance System (BRFSS) questions about smoking, obesity, health insurance, and mammography use were aggregated for 1992–1998 by county. These data were then geographically smoothed by adjusting each county’s proportional response based on the responses of its neighboring counties. Results: The maps show risk factor patterns consistent with published state-level maps, but also identify within-state variations masked by aggregation to the larger geographic units. Conclusions: The risk factor maps presented should permit a better understanding of localized patterns of health risk behaviors and access to health care as well as help to target intervention activities in the U.S. areas that most need them.

Patterns of health risk behaviors for chronic disease: A comparison between adolescent and adult american indians living on or near reservations in Montana

To compare the chronic disease health risk behavior patterns of adolescents and adults among American Indians living on or near reservations in Montana. We analyzed data from the 1993 Youth Risk Behavior Survey of American Indians in Grades 9-12 living on or near Montana reservations. Risk factors included tobacco use, low physical activity, attempted weight loss, and low consumption of fruits, vegetables, and green salad. Similar data were analyzed from a 1994 Behavioral Risk Factor Survey of American Indian adults living on or near reservations in Montana. The prevalence of most adolescent health risk behaviors was high, especially cigarette smoking (45% for males, 57% for females), smokeless tobacco use (44% for males, 30% for females), and infrequent consumption of salad or vegetables (59-76%). With the exception of daily cigarette smoking and inadequate fruit consumption among adolescents of both genders and physical inactivity among adolescent males, the prevalence of chronic disease health risk behaviors among adolescents was similar to or higher than the prevalence of the same risk behaviors among adults. Many health risk behaviors for chronic diseases are common by the time this group of American Indians in Montana has reached adolescence. Possible reasons may include modeling of familial behaviors, peer pressure, advertising, or age cohort effects. If these risk behavior patterns continue into adulthood, morbidity and mortality from chronic diseases are likely to remain high. Substantial efforts are needed to prevent or reduce health risk behaviors among adolescents and adults in this population.