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

Patterns of Health-Risk Behaviours and Their Associations With Anxiety and Depression Among Chinese Young Adults by Gender: A Latent Class Analysis

This study investigated gender differences in health-risk behaviour patterns among young adults and assessed the associations of anxiety and depression with these patterns. A cross-sectional survey was conducted with 1740 young Chinese adults aged 18-24 years. Latent class analysis (LCA) and multinomial logistic regression were conducted to identify the clusters of health-risk behaviours and their associations with anxiety and depression. Three common patterns were found for both genders: physical inactivity, substance use, and insufficient fruit intake (5.7% for males [M] and 11.6% for females [F]); a sedentary lifestyle only (48.4% for M and 48.9% for F); and a sedentary lifestyle, substance use, and an unhealthy diet (7.6% for M and 20.0% for F). Additionally, two additional unique patterns were found: physical inactivity and unhealthy diet in males (38.3%) and physical inactivity and insufficient fruit intake in females (19.6%). Sociodemographic variables exert different effects on health-risk behaviour patterns as a function of gender. Lower anxiety levels (odds ratio [OR]: 0.892; 95% confidence interval [CI]: 0.823-0.966) and greater depression levels (OR: 1.074; 95% CI: 1.008-1.143) were associated with a sedentary lifestyle, substance use, and unhealthy diet class only in female young adults compared with a sedentary-only class. These findings underscore the need for the implementation of targeted interventions based on gender differences.

Sex Differences in Clustering Unhealthy Lifestyles Among Survivors of COVID-19: Latent Class Analysis

BACKGROUND

The COVID-19 pandemic has underscored the significance of adopting healthy lifestyles to mitigate the risk of severe outcomes and long-term consequences.

OBJECTIVE

This study focuses on assessing the prevalence and clustering of 5 unhealthy lifestyle behaviors among Vietnamese adults after recovering from COVID-19, with a specific emphasis on sex differences.

METHODS

The cross-sectional data of 5890 survivors of COVID-19 in Vietnam were analyzed from December 2021 to October 2022. To examine the sex differences in 5 unhealthy lifestyle behaviors (smoking, drinking, unhealthy diet, physical inactivity, and sedentary behavior), the percentages were plotted along with their corresponding 95% CI for each behavior. Latent class analysis was used to identify 2 distinct classes of individuals based on the clustering of these behaviors: the "less unhealthy" group and the "more unhealthy" group. We examined the sociodemographic characteristics associated with each identified class and used logistic regression to investigate the factors related to the "more unhealthy" group.

RESULTS

The majority of individuals (male participants: 2432/2447, 99.4% and female participants: 3411/3443, 99.1%) exhibited at least 1 unhealthy behavior, with male participants being more susceptible to multiple unhealthy behaviors. The male-to-female ratio for having a single behavior was 1.003, but it escalated to 25 for individuals displaying all 5 behaviors. Male participants demonstrated a higher prevalence of combining alcohol intake with sedentary behavior (949/2447, 38.8%) or an unhealthy diet (861/2447, 35.2%), whereas female participants tended to exhibit physical inactivity combined with sedentary behavior (1305/3443, 37.9%) or an unhealthy diet (1260/3443, 36.6%). Married male participants had increased odds of falling into the "more unhealthy" group compared to their single counterparts (odds ratio [OR] 1.45, 95% CI 1.14-1.85), while female participants exhibited lower odds (OR 0.65, 95% CI 0.51-0.83). Female participants who are underweight showed a higher likelihood of belonging to the "more unhealthy" group (OR 1.11, 95% CI 0.89-1.39), but this was not observed among male participants (OR 0.6, 95% CI 0.41-0.89). In both sexes, older age, dependent employment, high education, and obesity were associated with higher odds of being in the "more unhealthy" group.

CONCLUSIONS

The study identified notable sex differences in unhealthy lifestyle behaviors among survivors of COVID-19. Male survivors are more likely to engage in unhealthy behaviors compared to female survivors. These findings emphasize the importance of tailored public health interventions targeting sex-specific unhealthy behaviors. Specifically, addressing unhealthy habits is crucial for promoting post-COVID-19 health and well-being.

The relationship between cumulative ecological risk and health risk behaviors among Chinese adolescents

OBJECTIVES

To explore the relationship between cumulative ecological risk and individual risky behavior and multiple forms of aggregated behaviors among adolescents, and examine the gender differences.

METHODS

A large-scale, nationally representative, and students-based investigation was conducted in rural and urban areas of eight provinces in China from October to December 2021. A total of 22 868 adolescents with an average age of 14.64 years completely standardized questionnaire in which the sociodemographic characteristics, socio-ecological risk factors and risky behaviors were used to analyze.

RESULTS

Of included students, 48.4% encountered the high level of social-ecological risk. The prevalence of breakfast intake not daily, alcohol use (AU), smoking, physical inactivity, prolonged screen time (ST) on weekdays and weekends, suicidal ideation, suicidal plan, suicidal attempt, and non-suicidal self-injury (NSSI) was 41.0%, 11.9%, 3.4%, 61.9%, 15.1%, 51.1%, 27.7%, 13.9%, 6.5% and 27.0% respectively. 22.2% of participants engaged in high-risk behaviors. All were significantly influences of increased cumulative ecological risk on individual behavior and low-risk clustering behaviors separately. The odds ratio of breakfast intake not daily, AU, smoking, physical inactivity, prolonged ST in weekday and weekend, suicidal ideation, suicidal plan, suicidal attempt, and NSSI for the adjusted model in low versus high level of cumulative ecological risk was respectively significant in both boy and girls, and the ratio of odds ratios (ROR) was separately 0.95 (p = 0.228), 0.67 (p < 0.001), 0.44 (p < 0.001), 0.60 (p < 0.001), 0.78 (p = 0.001), 0.83 (p = 0.001), 0.80 (p = 0.001), 0.83 (p = 0.022), 0.71 (p = 0.005), 0.75 (p = 0.001). Girls encountering a high level of cumulative ecological risk were more likely to engage in multiple forms of clustering risky behaviors than boys (RORs: 0.77, p = 0.001).

CONCLUSIONS

Research and effective inventions at the social-ecological environment, based on the view of cumulative risk, are needed to promote the healthy development of behaviors in adolescence, and pay more attention to decreasing the occurrence of risky behaviours in girls than boys.

Gender differences in social environmental factors of psychological distress among Indonesian adolescents: Findings from the 2015 Global School-based Student Health Survey

BACKGROUND

This study aimed to investigate gender differences in social environmental factors of psychological distress among Indonesian adolescents.

METHODS

This was a cross-sectional study using the data from the 2015 Indonesia Global School-based Student Health Survey. Binary logistic regression was used to assess the influences of main independent variables - social environmental factors (i.e., peer support, having close friends, bullying victimisation, physical fight, physical attack, parental supervision, connectedness, bonding), demographic characteristics, and health-related behaviours on the measures of psychological distress (loneliness, anxiety-induced sleep disturbance, and a combination of both measures as psychological distress).

RESULTS

The prevalence of psychological distress measured as loneliness, anxiety-induced sleep disturbance, and combined psychological distress was 6.12%, 4.52%, and 8.04%, respectively. Findings from multivariate analyses indicated that bullying victimisation, physical attack, experience of hunger (a proxy of socioeconomic status), and sedentary behaviour were associated with all measures of psychological distress. Meanwhile, age, gender, drug use, parental connectedness and bonding, and having no close friends were correlates of one or two measures of psychological distress. Based on gender-stratified analyses, experience of hunger, sedentary behaviour, bullying victimisation, and having no close friends were consistently associated with measures of psychological distress among both girls and boys. In addition, the influence of some social environmental factors, such as parental connectedness, peer support, and physical attack, were more salient among girls.

CONCLUSIONS

The findings suggest that social environmental factors, demographic characteristics, and health-related behaviours were associated with psychological distress, and the associations appeared to differ by gender. Interventions that include improving positive social environmental factors (e.g., reducing interpersonal violence, encouraging positive relationships with parents and peers) and promoting healthy behaviours (e.g., less sedentary behaviour, preventing substance use) might help reduce the risk of psychological distress among Indonesian adolescents.

A Systematic Review Protocol for the Effectiveness of Psycho-Educational Intervention Programmes in Addressing the Psychological Risk Factors Associated with Non-Communicable Diseases among Adolescents

The psychological health concerns and risk factors associated with non-communicable disease among adolescents have been prioritized on the agenda of international health institutions globally. The aims of this systematic review are to determine the various types of psycho-educational intervention programmes developed to address the psychological risk factors associated with non-communicable diseases among adolescents, and to assess the effectiveness of the psycho-educational intervention programmes. The systematic review will include case-control and randomized controlled studies. The review will be conducted using the following electronic databases, PubMed, CINAHL, Science Direct, Cochrane Library, SCOPUS, and ERIC, as well as the grey literature for the thesis repository from 2012 to 2022. The key search terms will include intervention programme, adolescents (aged 10-19 years), psychological risk factors and non-communicable diseases. The studies identified by the search strategy will be downloaded into Mendeley and exported to Covidence software for screening, quality assessment and data extraction. The quality assessment tool that will be utilized is the Joanna Briggs Institute critical appraisal checklists to ensure relevance and quality of the articles. This systematic review will use two types of data analysis: narrative synthesis of qualitative studies and meta-analysis of quantitative studies. The findings from this systematic review will provide evidence-based tools for the management of psychological risk factors associated with non-communicable diseases, as well as present key insights for future intervention programmes on the management of psychological risk factors associated with NCDs among adolescents.

Lifestyle habits, macronutrient intake, and obesity prevalence among adolescents in rural-periurban community senior high schools in the Ho municipality of Ghana

Background

Adolescence is a critical stage in the life cycle that presents a window of opportunity for the formation of lifetime habits or an aversion to childhood malnutrition effects. This study assessed the lifestyle habits, macronutrient intakes, and obesity prevalence among adolescents in some selected Senior High Schools in rural communities in Ho Municipality.

Materials and methods

A cross-sectional survey was conducted among 272 adolescents aged 13–19 years and attending senior high schools in the Ho Municipality of Ghana. Data on sociodemographic, physical activity levels, dietary habits, and anthropometrics were obtained. A body mass index (BMI) and waist circumference (WC) were determined, while a repeated 24-h dietary recall was used to collect the dietary intakes of the participants.

Results

The majority of the adolescents did not meet the Recommended Dietary Allowances (RDA) for calories (94.5%), dietary protein (68.8%), and fibre (91.5%). Adolescent boys consumed more calories (1,969.7 ± 579.9 Kcal) on average than adolescent girls (1,658.0 ± 458.7 Kcal) (p = 0.001). Overweight and obesity prevalence were 15.8 and 8.5%, respectively. About 90.4% of the adolescents did not meet the WHO recommended 150 min per week of physical exercise. On sedentary, 97.6% of adolescents spent half an hour to 5 h per day watching television when at home. Breakfast was the most frequently skipped meal (47.9%), and 59.6% of adolescents consumed fast foods such as pizza, burgers, and ice cream one to three times per week. Adolescent girls also had higher odds of being overweight or obese compared with adolescent boys (AOR = 2.4, p = 0.094, 95% CI = 0.9–6.4). Adolescents who did not meet the RDA for calories had lower odds of being overweight or obese compared with those who did (UOR = 0.3, p = 0.045, 95% CI = 0.1–0.9).

Conclusion

Poor dietary habits and intake, sedentary lifestyle, and obesity prevalence were observed among the adolescents. Being an adolescent girl was associated with obesity risk, while not meeting caloric intake showed a protective effect. Efficient and effective nutrition and lifestyle education programme should be promoted in communities to improve the dietary intake and lifestyle habits of adolescents.

Clustering of health behaviors among Japanese adults and their association with socio-demographics and happiness

Background

Scholars have associated happiness with health behaviors, which co-occur and exert synergistic effects. Therefore, identifying clusters of health behaviors and their effect on happiness can contribute to the development of strategies for promoting happiness and improving health behaviors.

Aim

This study aimed to examine clusters of health behaviors and their associations with socio-demographics and with happiness among Japanese adults.

Methods

This study used data from the Japanese Household Panel Survey and the Keio Household Panel Survey. Questionnaires were distributed to 4,993 households out of which 1,554 responses were analyzed (participants aged 27−65 years). The survey included health behaviors (alcohol consumption, smoking, vegetable and fruit consumption, breakfast-eating habits, and physical activities), happiness, and socio-demographics. Latent class analysis was conducted to identify the clusters, whereas latent regression was employed to investigate socio-demographics related to the clusters. Logistic regression analysis was conducted to examine the relation between happiness and the clusters.

Results

Two health behavior clusters were identified: Cluster 1 (low substance use and good dietary habit; n = 817; 52.3%) and Cluster 2 (high alcohol, poor nutrition, and inactive; n = 737; 47.7%). Latent regression analysis indicated that all socio-demographics, barring socioeconomic status, were significantly associated with the clusters. The “low substance use and good dietary habit” cluster was significantly related with higher odds of happiness (odds ratio = 1.425, 95% confidence interval = 1.146−1.772, p = 0.001).

Conclusions

This study identified health behavior clusters among Japanese adults and established the association between the “low substance use and good dietary habit” cluster and high levels of happiness. However, the causality of the relationship between health behavior and happiness remains unclear, which highlights the need for further research to elucidate the underlying mechanisms.

Identifying the latent classes of modifiable risk behaviours among diabetic and hypertensive individuals in Northeastern India: a population-based cross-sectional study

OBJECTIVE

To identify the latent classes of modifiable risk factors among the patients with diabetes and hypertension based on the observed indicator variables: smoking, alcohol, aerated drinks, overweight or obesity, diabetes and hypertension. We hypothesised that the study population diagnosed with diabetes or hypertension is homogeneous with respect to the modifiable risk factors.

DESIGN

A cross-sectional study using a stratified random sampling method and a nationally representative large-scale survey.

SETTING AND PARTICIPANTS

Data come from the fourth round of the Indian National Family Health Survey, 2015-2016. Respondents aged 15-49 years who were diagnosed with either diabetes or hypertension or both were included. The total sample is 22 249, out of which 3284 were men and 18 965 were women.

PRIMARY AND SECONDARY OUTCOME MEASURES

The observed variables used as latent indicators are the following: smoking, alcohol, aerated drinks, overweight or obesity, diabetes and hypertension. The concomitant variables include age, gender, education, marital status and household wealth index. Latent class model was used to simultaneously identify the latent class and to determine the association between the concomitant variables and the latent classes.

RESULTS

Three latent classes were identified and labelled as class 1: 'diabetic with low-risk lifestyle' (21%), class 2: 'high-risk lifestyle' (8%) and class 3: 'hypertensive with low-risk lifestyle' (71%). Class 1 is characterised by those with a high probability of having diabetes and low probability of smoking and drinking alcohol. Class 2 is characterised by a high probability of smoking and drinking alcohol and class 3 by a high probability of having high blood pressure and low probability of smoking and drinking alcohol.

CONCLUSIONS

Co-occurrence of smoking and alcohol consumption was prevalent in men, while excess body weight and high blood pressure were prevalent in women. Policy and programmes in Northeastern India should focus on targeting multiple modifiable risk behaviours that co-occur within an individual.

Associations between mental health problems and risky oral and sexual behaviour in adolescents in a sub-urban community in Southwest Nigeria

BACKGROUND

This study determined the association between mental health and risky oral health and sexual health behaviours.

METHODS

A household cross-sectional survey was conducted in Ile-Ife, Nigeria between December 2019 and January 2020. Data were collected from 10 to 19-year-old on the sociodemographic profile (age, sex at birth and socioeconomic status); mental health problems (psychological distress, depressive symptoms and suicidal ideation); and mental (smoking habit, consumption of alcohol, use of psychoactive substances), sexual (history of vaginal or anal sexual intercourse; transactional sex, multiple sex partners, use of condom at last sexual intercourse) and oral (frequency of daily tooth brushing, daily frequency of consumption of refined carbohydrate in-between-meals, frequency of use of dental floss, history of dental service utilization in the last 12 months and dental anxiety) health risk factors. Binary logistic regression analysis was conducted to determine the association between risky oral (neglecting to brush twice daily and frequent consumption of refined carbohydrates in-between-meals), and sexual (neglecting to use condoms during the last sex act and having multiple sex partners) health behaviours as outcome variables, and mental health status as the explanatory variables. An ordinal logistic regression model was also developed where the outcome variable was the number of risky health behaviours. The models were adjusted for the socio-demographic variables and history of dental service utilisation in the last 12 months of the survey.

RESULTS

High psychological distress was significantly associated with lower odds of frequent consumption of refined carbohydrates in-between-meals (AOR = 0.32; 95%CI 0.23, 0.47), and having multiple sex partners (AOR = 0.10; 95%CI 0.02, 0.57); but higher odds of having a higher number of risky behaviours (AOR = 3.04; 95%CI 2.13, 4.33). Having depressive symptoms was significantly associated with higher odds of neglecting to use condom at the last sexual intercourse (AOR = 7.20; 95%CI 1.94, 26.76) and having multiple partners (AOR = 95.43; 95%CI 24.55, 370.90). Suicidal ideation was significantly associated with lower odds of neglecting to use condom at the last sexual intercourse (AOR = 0.00; 95%CI 0.00, 0.00) and having multiple sex partners (AOR = 0.00; 95%CI 0.00, 0.00).

CONCLUSION

The associations between psychological distress and oral and sexual health risk behaviours in adolescents seem complex and need to be studied further.

Using Latent Class Analysis to Identify Health Lifestyle Profiles and Their Association with Suicidality among Adolescents in Benin

Youth suicidality is considerably prevalent in low- and middle-income countries, including Benin. Factors such as psychosocial distress, socio-environmental factors, and health risk behaviors are associated with suicidality. However, little is known about how these factors co-occur in these countries. An analysis of these factors taken together would help to identify the profiles most at risk and better target prevention policies. Our study aimed to identify profiles related to these factors and their association with suicidality among adolescents in Benin. Data from the 2016 Global School-Based Student Health Survey were used, and factors related to lifestyle (tobacco and alcohol consumption and physical activity), physical violence, parental support, and psychological distress were studied. Latent class analysis was used to identify the profiles, and a modified Poisson regression with generalized estimating equations, adjusted for sociodemographic characteristics, was performed to assess the association between these profiles and suicidality. The survey results show that globally, 13.8% of the adolescents (n = 2536) aged 11 to 18 had thought about suicide, 15.6% had planned suicide, and 15.6% had attempted suicide. Four profiles were identified: a low-risk group, one with psychological distress problems, a group with violence problems, and one with alcohol, tobacco, and violence problems. The risk of suicidality, in terms of ideation, planning, or attempting, was higher for adolescents in Profiles 2, 3, and 4 than those in Profile 1 (p < 0.05). Adolescents in Profile 2 were particularly affected by this increased risk (prevalence ratio (PR) for ideation = 1.13, 95% CI = 1.03–1.23; PR for planning = 1.12, 95% CI = 1.04–1.22; PR for attempting = 1.09, 95% CI = 1.01–1.17). This study highlights the typical profiles that may be linked with suicidality among adolescents in Benin. A holistic consideration of these factors could help in planning better preventive measures to reduce suicidality among adolescents in Benin.

A Latent Class Analysis of Health Lifestyles in Relation to Suicidality among Adolescents in Mauritius

Suicidality, which includes suicidal thoughts, planning, and suicide attempts, results mainly from a combination of psychological, sociological, and environmental factors. Despite a high prevalence of suicidality among adolescents in Africa, only a few studies have considered these factors simultaneously. The objective of the study was to identify the prevalence of suicidality, to draw up profiles of concomitant risks, and to examine the associations between these profiles and suicidality in Mauritius. This study used data from the 2017 Mauritian Global School-based Student Health Survey including 3012 adolescents with a mean age of 14.9 ± 1.4 years. Factors related to lifestyle such as consumptions of alcohol and tobacco, physical activity, violence, parental support, anxiety, and loneliness were considered. A latent class analysis was performed to identify the profiles. Finally, a modified Poisson regression analysis with generalized estimating equations, adjusted with sociodemographic characteristics, was used to assess the association between these profiles and suicidality. Overall, more than one in ten adolescents had at least one of the suicidality behaviors. Three profiles were identified: 1 = "low risk group" (63.9%); 2 = "problems with violence" (15.2%); 3 = "problems with violence, alcohol, tobacco and psychological distress" (20.9%). Profiles 2 and 3 were mainly made up of males. Adolescents under 15 represented the majority of individuals in profile 2. Finally, the risk of suicidality was higher in adolescents belonging to profiles 2 and 3 compared to profile 1 for the three suicidality behaviors (profile 3: Prevalence ratio (PR) for suicidal thoughts = 1.26, 95% CI = 1.19-1.34; PR for planning = 1.23, 95% CI = 1.17-1.30; PR for attempt = 1.23, 95% CI = 1.17-1.29). This study highlights the high prevalence of suicidality and a list of concomitant risks, emphasizing this suicidality in Mauritian adolescents. Therefore, these results recommend focusing preventive efforts toward a simultaneous consideration of these factors.