We examined the psychosocial factors that predict sexual risk behaviour of adolescents who reside in HIV affected homes in Uganda, to provide evidence for developing suitable interventions. Structured questionnaires were used to collect data about these adolescents' psychosocial and sexual experiences. The scales and data were verified for precision and reliability using factor analyses, while the predictors of sexual risk behaviour were examined using general linear models. Results showed that having been female, in the younger adolescence stage and a Muganda or Lango, living with one caregiver, being a recipient of HIV/psychosocial care and vulnerable to negative peer influence, personal threats, interpersonal problems, psychosocial distresses (e.g. psychosis and delinquency) and coping by deflecting problems, significantly enabled sexual risk behaviour in these adolescents. However, attending school, religious conviction, experiencing orphanhood especially of the mother, living with two caregivers, and experiencing poverty, judgmental HIV stigma, distress (e.g. inattention and depression), self-control and social support significantly deterred it. These results highlight the centrality of gender, age, HIV care, family situations, sociocultural and peer norms, community stressors, psychosocial distresses, and negative coping methods in influencing sexual risk behaviour of adolescents who reside in HIV affected homes. Interventions by families, schools and agencies are needed to prevent or mitigate these risk factors.

ABSTRACT Bullying negatively impacts child development, increasing risks for deviant behaviors and poor health outcomes. Racial/ethnic minority youth experience high rates of bullying. This study examines the relationship between the frequency of middle childhood bullying victimization and adolescent risk behaviors, including fighting, marijuana use, sexual activity, physical inactivity, and sleep problems. Racial/ethnic differences in these associations are also explored. An analytical sample of 2,678 children and their primary caregivers was derived from Waves 1 (birth), 5 (age 9), and 6 (age 15) of the Future of Families and Child Wellbeing Study. Frequency of middle childhood bullying victimization was assessed via a composite index, and risk behaviors were self-reported or reported by primary caregivers. Path and multi-group path analyses examined associations between bullying victimization and risk behaviors and whether racial/ethnic differences existed. Frequent bullying victimization significantly predicted fighting, sleep problems, and physical inactivity, but not sexual activity or marijuana use. While our multi-group path analysis found no statistically significant racial/ethnic differences in the association between frequent bullying victimization and the outcome variables, the findings do indicate that Latino/Hispanic youth had higher levels of risk behavior outcomes. Bullying victimization can have lasting consequences for all young people. Social personnel are crucial in early intervention initiatives to combat and alleviate the harmful effects of bullying and to foster healthy development.

BackgroundThe Co-occurrence of Health Risk Behaviors (ACEs) among adolescents has become a significant public health issue that urgently needs to be addressed. This study aims to investigate the prevalence of Co-occurrence of Health Risk Behaviors among adolescents and to explore the mediating role of self-efficacy (SE) and self-control (SC) in the relationship between adverse childhood experiences and Co-occurrence of Health Risk Behaviors (CHRBs). MethodsA total of 7901 adolescents in China were surveyed using the following instruments: the Adolescent Health Risk Behaviors Survey Questionnaire, the Patient Health Questionnaire-9 (PHQ-9), the Mobile Phone Addiction Index (MPAI), the Adverse Childhood Experiences Questionnaire (ACEQ), the General Self-Efficacy Scale (GSES), and the Self-Control Scale (SCS). Data were analyzed using SPSS 25.0 software.Results(1) Adverse childhood experiences significantly and positively predicted Co-occurrence of Health Risk Behaviors among adolescents (p < 0.05). (2) Adverse childhood experiences indirectly influenced Co-occurrence of Health Risk Behaviors through the partial mediating effects of self-efficacy and self-control (p < 0.05). (3) Adverse childhood experiences also indirectly influenced Co-occurrence of Health Risk Behaviors through the chained mediating effects of self-efficacy and self-control (p < 0.05).ConclusionsThis study further elucidates the relationship between adverse childhood experiences and Co-occurrence of Health Risk Behaviors among adolescents, as well as the chained mediating role of self-efficacy and self-control. These findings confirm the mechanism by which adverse childhood experiences influence Co-occurrence of Health Risk Behaviors. The results suggest that creating a favorable living environment for children and adolescents should become a societal consensus. Additionally, when intervening with adolescents who exhibit problematic behaviors, it is important to focus on enhancing their self-efficacy and self-control to mitigate the long-term impact of adverse childhood experiences.

IntroductionEarly adolescence is a crucial period of change, during which some youths begin to engage in externalizing and internalizing risk behaviors. Prevention at an early stage is vital to prevent more serious issues later. Although parental influence decreases and peer influence increases during this time, parental behavior still plays a significant role. This study examined the impact of parenting psychological control and warmth on the occurrence of risk behaviors in early adolescence, with susceptibility to peer pressure and self-esteem serving as potential mediators.MethodsThe sample consisted of 410 eighth-grade students with an average age of 14 years. The instruments used were the Scale of Perception of Family Relationships, Susceptibility to Peer Pressure Scale, Rosenberg Self-Esteem Scale, and two subscales assessing risk-taking behavior among youth, which are part of the Self-Reported Risk and Delinquent Behavior Questionnaire.ResultsThe findings indicate that while models with both mediators included were confirmed, those in which peer pressure susceptibility mediated the relationship between parental behaviors and mild externalizing risk behaviors demonstrated a better fit. In contrast, in the relationship between parental behavior and internalizing risk behaviors, self-esteem emerged as a more effective mediator. All models showed partial mediation, indicating that only a portion of the influence of parenting behavior on the occurrence of risk behaviors is accounted for by these mediators. Analyses presented here focus on maternal data, with paternal results showing highly similar patterns.DiscussionThe contribution of this study lies in the finding that parental warmth and psychological control and the development of mild externalizing and internalizing risk behaviors are mediated in somewhat different ways with respect to self-esteem and susceptibility to peer pressure. Aside from scientific implications, these results also have practical implications, as they suggest more concrete intervention strategies that can be implemented in family and school settings to mitigate risk behaviors.

IntroductionParent-adolescent relationships play a crucial role in influencing high-risk behaviors among adolescents. In Malaysia, there is limited research exploring the influence of parent-adolescent relationships on adolescent risk behaviors. This study aims to determine the role of parent-adolescent connectedness and parental monitoring against high-risk behaviors among Malaysian adolescents.MethodsThis study utilized data from the National Health and Morbidity Survey (NHMS) 2022: Adolescent Health Survey, a cross-sectional study conducted from June to July 2022 among secondary school students. A two-stage stratified cluster sampling method was applied using a national sampling frame of 2,798 schools to ensure state and national representativeness. The Global School-based Student Health Survey (GSHS) Malaysian version was used to collect data on health risk behavior and protective factors including parent-adolescent connectedness and parental monitoring. Descriptive analysis and multivariable logistic regression were used to analyzed the data.ResultsAmong 33,523 adolescents, a total of 24.2% (95% CI: 23.7–24.7) of adolescents reported parental connectedness, while 33.4% (95% CI: 32.9–33.9) reported parental monitoring. By sociodemographic factors, Indians ethnicity had the highest odds of reporting both parental connectedness (aOR: 1.94, 95% CI: 1.65, 2.28) and parental monitoring (aOR: 2.21, 95% CI: 1.82, 2.70), while adolescents in Labuan Federal Territory (a federally administered island region of Malaysia) had significantly lower odds for both measures. Adolescents with parents married and living together had significantly higher odds of reporting both parental connectedness (aOR: 1.28, 95% CI: 1.18, 1.40) and parental monitoring (aOR: 1.35, 95% CI: 1.26, 1.44). Parental connectedness and monitoring were strong protective factors against all eight high-risk behaviors, including reduced odds of sexual activity (aOR: 0.63 and 0.58), e-cigarette use (aOR: 0.68 and 0.55), smoking, drug use, alcohol use, physical fights, being bullied, and cyberbullying.ConclusionThis study found that parental connectedness and monitoring were significantly associated with lower odds of engaging in high-risk behaviors among Malaysian adolescents, with notable variations by ethnicity, parental marital status, and region. Strengthening parental involvement and addressing disparities in family dynamics are essential strategies for promoting adolescent health and well-being in Malaysia.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-24598-9.

PurposeNon-suicidal self-injury is a common risk behavior in adolescence but is often difficult to detect. This study employs interpretable machine learning techniques to develop a classification model for adolescent non-suicidal self-injury and elucidate pertinent factors. Employing diverse algorithms, a comprehensive analysis is conducted to discern critical risk and protective elements within a large dataset, evaluating their alignment with the Integrated Theoretical Model.MethodsIn partnership with educational institutions in eastern China, this research compiled data on behaviors and correlated factors through the administration of questionnaires, incorporating demographic information and seven validated scales. Analytical models were built using six machine learning techniques: K-Nearest Neighbors, Support Vector Machine, Logistic Regression, Light Gradient Boosting Machine, CatBoost, and eXtreme Gradient Boosting.ResultsThe analysis included a total of 2989 valid responses samples. Among the algorithms, CatBoost demonstrated superior performance, evidenced by an AUPRC of 0.736 and an AUC of 0.863. SHAP visualization highlighted 23 important items. Exploratory factor analysis identified seven factors, designated as Situational Anxiety, Depressive Symptoms, Positive Daily Functioning, Negative Self Esteem, Self-Appraisal of Behavior, Bullying and Reactive Aggression, and Interpersonal Problems and Self-Acceptance.ConclusionLeveraging multiple machine learning algorithms for a holistic item analysis, this research identifies critical risk and protective factors for non-suicidal self-injury, thus refining the Integrated Theoretical Model.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-24354-z.

Develop and evaluate the psychometric properties of an instrument that measures the main risk behaviors in adolescence. The study was conducted in two phases: first, the development of the instrument through content validation with experts in the field, and then a second phase was conducted with a cross-sectional design and non-probabilistic sampling for psychometric purposes. The sample consisted of a total of 100 adolescents with an age range of 12-17 years, recruited from a tertiary Pediatric Hospital in Guadalajara, Mexico. The participants who gave their consent to participate in the study answered the developed instrument. In total, 72 % were women, with age (x̄ 14.4). The final version of the questionnaire on risk behaviors in adolescents consisted of three dimensions: high prevalence, dissocial, accidents; and 12 items, with a Likert-type rating, whose answers are equivalent to a value of 0 for no risk, one for low risk and two for moderate risk, obtaining adequate content validity by the experts. The instrument as a scale showed good internal consistency (Cronbach's α 0.79) and as a dichotomous questionnaire KR-20 0.76. The exploratory factor analysis obtained three components, which together explained 56.9 % of the total variance; KMO 0.76 and Bartlett's sphericity test p 0.001. The confirmatory factor analysis supports the proposed model with at least five adequate fit indices (RMSEA 0.042, CFI 0.95, TLI 0.93, X2/gl1.17). The adolescent risk behavior questionnaire (Cuestionario de Conductas de Riesgo en la Adolescencia, CCRAC) is a spanish, brief, freely usable instrument that is easy to apply in multiple settings. Its psychometric characteristics make it reliable and valid for screening behaviors with potential negative consequences for health in clinical contexts.

BackgroundThis study examined the association between problematic smartphone use (PSU) and risk behaviors among Korean adolescents during the COVID-19 pandemic. It also aimed to develop preventive measures for adolescent health promotion in the event of future pandemics.MethodsA secondary analysis of data from the 16th Korean Youth Risk Behavior Web-based Survey (2020) was conducted, which included 54,948 middle and high school students. Smartphone use, PSU, alcohol use, and smoking status were assessed via self-reported questionnaires. Complex samples descriptive statistics and logistic regression analyses were performed using SPSS 25.ResultsKorean adolescents averaged 282.8 and 393.4 min of smartphone use across weekdays and on weekends, respectively, with a 25.5% prevalence of PSU. Female and high school students exhibited significantly higher PSU rates (p <.001). Current alcohol use and smoking increased PSU risk by 1.098- and 1.295-fold, respectively.ConclusionsThe findings emphasize the need for intervention strategies targeting PSU and associated risk behaviors. Continuous monitoring in home and school settings, along with gender-specific and educational-level interventions, is recommended to promote healthy smartphone use among adolescents.

Clustering of risk behaviors and classification performance in modeling adolescent risk: The example of the association between E-cigarette use and cigarette smoking.

Introduction: In sub-Saharan Africa, approximately six out of seven new HIV infections occur among adolescents aged 15-19 years. Adolescents face unique challenges that impact their sexual health and risk behavior. However, very few studies have systematically investigated the association between the household structure, parental co-residence and adolescent risky sexual behavior, yet understanding this association is key to designing supportive environment-specific interventions to improve these risky sexual behaviors. This study focused on the impact of household structure and coresidence on adolescent risky sexual behaviour. Methods: Data from a population-based HIV surveillance cohort was used. Household structure was defined by parents' vital status (alive or deceased), co-residence with parents, and living apart from parents. HIV risk behaviors included self-report of &gt;=1 non-marital sexual partner, multiple sexual partners, unprotected sex with a non-marital partner, and transactional sex. Poisson regression was used to estimate prevalence ratios for each risk behavior. Results: Among adolescents 15-19 years (n=3,234), 35% lived with both parents, 2.5% were double orphans. HIV risk behaviors included non-marital sexual partnership (17.5%), multiple sexual partners (10.5%), and transactional sex (11.5%). Adolescents whose mothers were resident, with non-resident father had increased prevalence; [non-marital partner (aPR=1.46 95%CI: 1.18-1.80), unprotected sex with a non-marital partner (aPR=1.23 95%CI: 1.00-1.51)]. Adolescents with both parents outside the home had increased prevalence; [multiple sexual partners (aPR=1.35 95%CI: 1.04-1.75), transactional sex (aPR=1.51 95%CI: 1.11-2.05)] as compared to those living with both parents. Conclusion: Household structure and co-residence with parents play significant roles in shaping the sexual behaviors of adolescents.

Objective: This study used a large U.S. population-based dataset to examine associations between childhood attention problems and adolescent substance use, sexual risk behavior, and delinquency. Methods: This prospective cohort study used data from the Future of Families and Child Wellbeing Study (n = 2,716). Bivariate statistics, multivariable logistic regression, and negative binomial models assessed associations between attention problems at age 9 years and subsequent use of cigarettes, alcohol, and marijuana, engagement in sex without a condom, and delinquency at age 15 years. Results: Nearly one-fifth (18.3%) of adolescents had elevated scores (more than 1 standard deviation above the sample mean) for attention problems at age 9 years. Adolescents with elevated attention problem scores in childhood were more likely than adolescents who did not have elevated scores to have ever smoked an entire cigarette (9% vs. 4%) and ever tried marijuana (24% vs. 20%). Elevated attention problem scores were associated with higher odds of ever having smoked an entire cigarette (adjusted odds ratio [AOR] = 2.06, 95% CI [1.39, 3.05], p < .01) and higher delinquent behavior scores (incidence rate ratio [IRR] = 1.30, 95% CI [1.11, 1.53], p < .01). In adjusted models, there were no significant associations between elevated attention problem scores and ever having tried marijuana, consumed alcohol, or engaged in unprotected sex. Conclusions: This study found that elevated attention problem scores in childhood were associated with higher risk of cigarette smoking and delinquent behaviors in adolescence. Results provide support for screening for attention problems among elementary school-age children and early intervention strategies to prevent health risk behaviors in adolescence.

Adolescent risk behaviors, including alcohol use and antisocial behaviors, remain a public health concern in Finnmark, Arctic Norway. However, the mechanisms linking risk and protective factors to these behaviors remain underexplored. This study examines the influence of individual and environmental factors-such as family, peers, school, and local contexts-on adolescent alcohol use and antisocial behaviors. Using data from the 2021 Ungdata survey (N = 2,129 high school students), Partial Least Squares Structural Equation Modeling was applied to identify key associations. The results indicate that unstructured peer interactions, particularly spending evenings with friends, are strongly associated with both alcohol use and antisocial behaviors. In contrast, time spent on online gaming was associated with reduced risk of these behaviors, while social media use was positively linked to alcohol consumption. Experiences of sexual harassment, as well as other co-occurring risk behaviors such as smoking, drug use, bullying, and aggression, were consistently associated with increased engagement in both alcohol use and antisocial behaviors. Family and school environments showed limited associations with alcohol use but were linked to antisocial behaviors. Socioeconomic status and gender were not significantly related to either outcome, while depressive symptoms and religiosity showed selective associations, primarily with alcohol use. The findings underscore the need for peer-oriented preventive strategies and consideration of digital media exposure in addressing adolescent alcohol use and antisocial behavior. Future research should incorporate ethnicity-related variables to enhance contextual understanding of adolescent behaviors in the Finnmark region.

Identifying and categorizing online risk behaviors is crucial for assessing their impact on adolescents. Despite extensive research, previous studies have not provided a clear classification of these behaviors. This systematic review synthesizes the quantitative literature on adolescent online risk behaviors from the inception of research to September 2023, aiming to: (a) offer a comprehensive overview of the types of online risk behaviors and the specific actions encompassed within each category among adolescents; (b) summarize the adverse outcomes associated with these behaviors; and (c) discuss the implications and future research directions. Utilizing key terms, this study sourced studies from four electronic databases (Scopus, PubMed, Web of Science, and EMBASE), ultimately including 22 English-language quantitative studies. The review reveals that online risk behaviors are primarily categorized into content risk behaviors, contact risk behaviors, and conduct risk behaviors. Adolescents engaging in these behaviors are at an increased risk of experiencing physical health issues, mental health problems, externalizing behaviors, and even self-harm and suicidal thoughts or actions. Further research is needed to develop and validate an online risk behavior scale and conduct longitudinal and experimental studies to establish causal relationships and examine the long-term effects of these behaviors on adolescent well-being. The review concludes with implications for future research and potential prevention, intervention, and policy strategies to mitigate online risk behaviors in adolescents.

Background Thalassaemia is a significant public health concern in Southeast Asia, yet little is known about health risk behaviours in adolescents with this condition. This study aimed to compare health risk behaviours between adolescents with thalassaemia and healthy controls, and to identify associated clinical and sociodemographic factors. Methods This cross-sectional study included 60 adolescents with thalassaemia (aged 10–18 years) and 60 age- and sex-matched healthy controls in Thailand. Health risk behaviours were assessed using the validated Thai Youth Risk Behaviour Survey. Clinical data were extracted from medical records. Multivariable logistic regression was used to identify factors associated with risk behaviours. Results Adolescents with thalassaemia reported higher rates of non-seatbelt use (25.0% vs. 1.7%, p < 0.001) and mental health problems (13.3% vs. 0.8%, p = 0.027) compared to controls. However, they exhibited lower rates of inadequate exercise (70.0% vs. 86.7%, p = 0.045) and excessive screen time (66.7% vs. 96.7%, p < 0.001). In the thalassaemia group, older age (aOR = 2.78, 95% CI: 1.09–7.09), female gender (aOR = 39.73, 95% CI: 0.89–1770.49) and lower pre-transfusion haemoglobin levels (aOR = 0.09, 95% CI: 0.01–0.64) were associated with increased odds of mental health problems. Higher pre-transfusion haemoglobin levels were associated with lower odds of violent behaviour (aOR = 0.44, 95% CI: 0.21–0.92). Conclusions Adolescents with thalassaemia exhibit distinct patterns of health risk behaviours, influenced by age, gender and disease severity. These findings underscore the need for integrated physical and psychosocial care, highlighting the importance of tailored health education and interventions for this vulnerable group.

The article addresses the pressing issue of adolescent upbringing within the context of extracurricular activities. It synthesizes scientific research on the formation of a value-based attitude toward health. The paper characterizes the features of how adolescents develop an appreciation for their own health and the motivational factors influencing their adherence to a healthy lifestyle. It analyzes the causes and manifestations of irresponsible health-related behaviors in adolescents across various behavioral patterns. The significance of adolescent behavioral stereotypes in shaping a propensity for risky behavior is substantiated. The study identifies current popular forms of risky behavior and highlights the role of a well-formed attitude toward health as a core life value in adolescents’ decision-making. It establishes a link between the normalization of risk-taking behavior among adolescents and an underdeveloped value-based attitude toward health. The influence of social behavioral stereotypes on the spread and acceptance of risky behaviors among adolescents is also examined. The research demonstrates an inverse correlation between the degree to which adolescents value their own health and their inclination toward risky behavior-the higher the value- based attitude toward health, the lower the propensity for risky conduct. The potential of extracurricular educational institutions in addressing this issue is analyzed. Key directions, forms, and methods of working with adolescents are justified, aiming to promote a positive shift in recognizing health as a personal value. The study concludes that extracurricular institutions play a crucial role as safe environments for development, alternative socialization, and self-realization of school-aged youth in socially acceptable forms of behavior and activity. The problem of forming motivation for a healthy lifestyle, as a means of preventing risky behavior among participants in extracurricular education, remains a subject for further research.

Providing recommendations for health education programming is a task well-suited for school nurses who are pediatric experts and well-trusted members of our communities. Using clinical expertise, national and community trends, emerging health risks, and their professional critical thinking skills, school nurses are key members of the team that plans, implements, and evaluates standardized health education curricula. This article highlights important guidelines and resources for school nurses and school health education teams to successfully and confidently conduct health education curriculum evaluations using a standardized feasibility evaluation approach. It emphasizes the importance of addressing the ever-changing risk behaviors of adolescents within health education curricula and the need for school nurses to offer evidence-based recommendations to academic teams based on their unique expertise.

Sexual behavior and its influencing factors among Uruguayan adolescents: a cross-sectional study.

Objective: This study aimed to explore the association between adolescents' health risk behaviours (excessive use of alcohol, (e)cigarette smoking, cannabis use) and familial factors. A special objective of this study was to compare findings between Bulgarian and Lithuanian adolescents aged 15 years. Material and Methods: National samples from the WHO Health Behaviour in School-aged Children (HBSC) survey in 2021/2022 were analysed. The focus was on adolescents aged 15 (n = 64,349), including those from Bulgaria (n = 793) and Lithuania (n = 1137). The set of outcome variables included drunkenness, smoked cigarettes, e-cigarettes, and used cannabis (all variables were measured during the last 30 days); their indicators were child's talking separately to their father and separately to their mother, as well as the four-item family support scale. All variables were dichotomised and their associations were analysed using Structural Equation Modelling with a WLSMV estimator. Results: In the total sample, the prevalence of drunkenness was 14.9%, cigarette smoking at 12.6%, e-cigarette smoking at 18.4%, and cannabis use at 5.9%; while in Bulgaria, in contrast to Lithuania, these behaviours were much more prevalent, at 27.0%, 29.9%, 29.8%, and 11.1%, respectively. The use of substances was significantly associated with selected familial factors, which were more pronounced among girls than boys in most subsamples. Low family support showed the strongest association with increased substance use (in the total sample, regression weight B varied from 0.231 to 0.382). Adolescents' difficulty in talking to mother was more pronounced (B = 0.123 to 0.204) than difficulty in talking to their father (B = 0.058 to 0.140). Comparison of data samples from Bulgaria and Lithuania showed stronger relationships in Bulgarian adolescents compared to other countries, which are more pronounced among boys. In addition, among Bulgarian adolescents, easy communication with their father had an inverse association (increasing prevalence) with cannabis use. Conclusions: Adolescent health risk behaviours, such as use of substances, are associated with familial factors, including parent-teen communication and family support. Generally, these associations are more pronounced among girls than boys, and more evident among Bulgarian adolescents than their Lithuanian counterparts. Identifying environmental factors in families helps to plan interventions to prevent development of multiple health risk behaviours in adolescents.

Adolescents' engagement in hazardous games has increased in recent years, presenting significant risks to physical and psychological well-being. These behaviors are often driven by complex psychosocial factors, including boredom, peer influence, and impulsivity. Understanding the specific motivations and profiles within this demographic is essential for developing effective interventions. Aims. This study aims to identify distinct adolescent profiles based on key psychosocial factors influencing engagement in hazardous games and to determine the primary predictors of risk-taking behavior. By exploring these profiles, we seek to inform targeted intervention strategies that address the unique needs of each group. A sample of adolescents was assessed using standardized measures of boredom susceptibility, social influence, impulsivity, and self-harm tendencies. Cluster analysis was employed to categorize participants into distinct profiles, and regression analysis identified significant predictors of engagement in hazardous games. Descriptive and inferential statistics were used to analyze differences across profiles. Four primary profiles emerged: High-Risk Boredom-Prone, Socially Influenced Risk-Takers, Impulsive Sensation-Seekers, and Vulnerable and Self-Destructive. Boredom susceptibility and social influence were found to be the strongest predictors of hazardous game participation. High-Risk Boredom-Prone adolescents were driven by a need for stimulation, while Socially Influenced Risk-Takers prioritized peer approval. The Impulsive Sensation-Seekers cluster showed a strong tendency toward thrill-seeking, and the Vulnerable and Self-Destructive profile indicated a coping mechanism linked to emotional distress. The findings highlight the importance of tailored interventions for adolescents, focusing on boredom management, peer resilience, and mental health support. Addressing these psychosocial drivers can help reduce the risks associated with hazardous games and support healthier developmental pathways. Future research should explore longitudinal data to track changes in adolescent risk behaviors over time and assess the impact of targeted interventions on each identified profile.

Childhood trauma has been associated with increased risk of substance use and poor sleep, with these factors linked to subsequent poor cardiovascular health. However, there has been little longitudinal research exploring these associations in adolescence, especially in low- and middle-income countries (LMICs). To address this, we investigated longitudinal pathways from trauma to risk behaviours and cardiovascular health indices among adolescents in the 2004 Pelotas Birth Cohort, Brazil. Lifetime cumulative trauma was assessed via caregiver reports up to age 11, and combined adolescent/caregiver reports at ages 15 and 18. At age 18, current problematic alcohol use, smoking, illicit drug use and sleep duration were measured via self-report and resting heart rate (HR) and blood pressure (BP) were assessed. We tested for trauma risk behaviour-HR/BP associations using multivariable regression, population attributable fractions and counterfactual mediation. Of 4,229 adolescents (51.9% boys), 81.9% were trauma-exposed by age 18. Cumulative trauma up to ages 15 and 18 increased the odds of age 18 alcohol, smoking and drug use (adjusted ORs: 1.25-1.44). Sleep duration was unrelated to childhood trauma. Population attributable fractions indicated that childhood trauma explained ≥28% of age 18 substance use. Unexpectedly, greater trauma exposure was associated with lower resting HR and BP. Substance use partially mediated the effect of trauma on cardiovascular health indices. Trauma is associated with substance use in LMIC adolescents. Prevention and intervention strategies targeting trauma are critical given this significant burden. Our finding that trauma predicts lower HR/BP warrants further exploration given well-established associations between trauma and poorer cardiovascular health in adulthood.