Concurrent multiple health risk behaviors among adolescents in Luangnamtha province, Lao PDR

Multiple risk-taking behaviors in Korean adolescents and associated factors: 2020 and 2021 Korea youth risk behavior web-based survey

OBJECTIVE

Despite the negative health impact of multiple risk-taking behaviors (RTBs), there is a lack of understanding of adolescents who are more prone to multiple RTBs. This study aimed to identify sociodemographic, mental, and physical health variables associated with increased susceptibility to multiple RTBs in each sex.

METHODS

Cross-sectional data from the 2020 and 2021 Korea Youth Risk Behavior Web-based Survey was used. A total of 106,979 Korean adolescents (55,460 men and 51,519 women) were assessed on five RTBs (alcohol use, smoking, sexual intercourse, illicit substance use, no seat belt wearing). In comparison to no RTB group, odds ratios of the relevant covariate factors were calculated in one RTB or multiple RTBs groups.

RESULTS

Male and female adolescents engaging in multiple RTBs were 6.4% and 3.8%, respectively. Increasing age, low subjective socioeconomic status, and living in rural areas were associated with multiple RTBs regardless of sex. All mental health variables except anxiety were associated with multiple RTBs in both sexes. Physical inactivity and obesity were associated with decreased odds of multiple RTBs in both sexes.

CONCLUSION

This study identifies diverse factors associated with multiple RTBs of Korean adolescents and demonstrates existing sex differences. Age and mental health status are the most critical factors that distinguish multiple risk-taking groups from those involved in one or no RTB.

Tobacco and alcohol co-use: Lifestyle and sociodemographic factors, and personality aspects as potential predictors in the "Seguimiento Universidad de Navarra" cohort

Tobacco and alcohol co-use are two major lifestyle modifiable risk factors. Understanding the determinants of both behaviors helps to develop interventions to prevent these exposures. However, previous studies have focused on predictors of individual tobacco or alcohol use. This study aims to explore the potential predictors of tobacco and alcohol co-use among Spanish university graduates from the "Seguimiento Universidad de Navarra" (SUN) cohort study. A total of 7175 participants who were co-users of tobacco and alcohol were selected for this cross-sectional analysis. Their mean age was 39.1 years (12.04 SD) and 57.3% were women. Univariate regression models were used to select the potential predictors of tobacco and alcohol co-use, and the areas under the ROC curves (AUC) were calculated. Multivariable logistic regression models were used to create a predictive model. Baseline potential predictors included sociodemographic factors, lifestyle habits, and perceived personality aspects. In the multivariable model, the main significant potential predictors of tobacco and alcohol co-use were driving under the influence of alcohol (odds ratio [OR] = 1.65 [1.43-1.90]), drinking 1-2 cups of coffee daily (OR = 1.50 [1.24-1.84]), drinking three or more cups of coffee daily (OR = 1.61 [1.35-1.91]), and doing more physical activity than recommended (OR = 1.18 [1.02-1.34]) when compared with the reference group. Conversely, those who were married (OR = 0.87 [0.75-0.99], ate at home 7 days a week (OR = 0.69 [0.60-0.80]), or had a high perceived level of competitiveness (OR = 0.83 [0.72-0.95]) had a lower risk of co-use (AUC 0.61 [confidence interval 95% 0.59-0.63]), compared to the reference group. These results could be used by healthcare professionals, especially nurses, to effectively assess patients at higher risk of tobacco and alcohol co-use. [Correction added on 16 February 2024, after first online publication: The abstract section has been revised to provide more clarity in this version.].

Investigating the relationship between high-risk behaviors and mental health in adolescents in Rabor city, Iran

OBJECTIVES

High-risk behaviors (HRBs) represent significant health threats for adolescents and significantly affect adolescents' mental health. Adolescents often engage in risky behaviors. The present study was conducted to investigate the relationship between high-risk behaviors (HRBs) and mental health in adolescents in Rabor.

CONTENT

The present study was a cross-sectional analytical study that was performed on 334 girl and boy students aged 12-18 years in Rabor city in 2021. In this study, adolescents answered high risk behaviors and mental health questionnaires. Data were analyzed using SPSS-26 software and the spearman correlation coefficient and linear regression analysis (univariate and multivariate analysis) were used to analyze the data.

SUMMARY AND OUTLOOK

In this study, the mean age was 15.25 ± 1.78. The findings indicate that smoking and hookah use were higher in boys than girls. Among the demographic variables, age and level of education had a positive and significant relationship with HRBs and mental health (p<0.05). The mean score of total mental health for all subjects was 12.83 ± 10.82. The variables of age, sex, marital status of parents, the number of children in the family, educational level, smoking, hookah, and alcohol have been determined as influential and facilitating factors in HRBs of adolescents. Father's literacy was considered as a facilitator and age variables, alcohol consumption and parents' marital status were considered as deterrents to mental health. The present study showed that the male gender is one of the risk factors for alcohol, smoking and other substances, the tendency to high-risk sexual behaviors, depression, and suicide in adolescents. Among the determinants of the tendency to HRBs in adolescents, psychological variables are of particular importance at the individual, social, and family levels. Good mental health can improve quality of life, while poor mental health can make it worse.

Factors affecting alcohol drinking behaviour among secondary school students in Vientiane Province, Lao People's Democratic Republic: a cross-sectional study

BACKGROUND

This study investigated alcohol consumption prevalence among adolescents in school settings in Lao People's Democratic Republic and identified factors associated with alcohol consumption to establish better school-based interventions.

METHODS

Self-administered questionnaires containing items assessing alcohol drinking behaviour and underlying factors were administered to 393 secondary school students ages 10-19 y. Multivariate logistic regression was used to predict factors associated with drinking behaviour.

RESULTS

Fifty-eight percent of respondents reported ever drinking alcohol. Among the drinkers, 52.6% were light drinkers, 16.8% were moderate drinkers, 27.0% were heavy drinkers and 3.5% were very heavy drinkers. Older age group (adjusted odds ratio [AOR] 5.2 [95% confidence interval {CI} 2.6 to 10.1]); peer pressure, particularly when more than two-thirds of friends drank alcohol (AOR 8.0 [95% CI 2.2 to 29.5]); and siblings' drinking behaviour (AOR 2.8 [95% CI 1.4 to 5.5]) were positively associated with alcohol use, while no permission to drink at home (AOR 0.2 [95% CI 0.1 to 0.6]), uncertain of permission to drink at home (AOR 0.06 [95% CI 0.02 to 0.1]) and never attempting to buy alcohol (AOR 0.2 [95% CI 0.1 to 0.4]) were negatively associated with respondents' alcohol use.

CONCLUSIONS

By the age of 19 y, most participating students had started drinking alcohol. One-third of them were permitted to drink by family members and drinking was strongly accelerated by peer pressure. Educational programmes are needed for adolescents attending school and their families that employ peer learning to raise awareness of the ill effects of alcohol use.

The 'big four' health risk behaviors among Vietnamese adolescents: co-occurrence and socio-cultural risk factors

Background

Health Risk Behaviors (HRBs) represent significant health threats for adolescents. However, there has been relatively little research on multiple HRBs in low-and-middle-income countries (LMIC), where the majority of the world’s youth reside. This study’s objective was to investigate common HRB, their co-occurrence, and socio-demographic risk and protective factors among Vietnamese adolescents.

Methods

A cross-sectional self-report survey examined four major HRBs (tobacco use, alcohol consumption, physical inactivity, unhealthy diet) among 431 adolescents aged 15–17 years in five Vietnam provinces. Key HRB risk and protective factors assessed included perceived social norms, parental monitoring of adolescents’ behavior, and health behavior literacy.

Results

Forty-one percent of participants reported no HRB, 39% reported one, and 20% reported two or more HRBs. The four HRBs appeared to be independent, with an exploratory factor analysis indicating no common factors. The most prevalent HRB was unhealthy diet (45%), the least prevalent smoking (1%). The most frequent co-occurring HRBs were unhealthy diet and physical inactivity. Adolescents’ perceptions of norms regarding HRBs and related healthy behaviors were the most consistent risk factor for the HRB. Diet was the HRB most influenced by the social variables perceived norms, monitoring, and health literacy.

Conclusions

Results highlight the importance of future research identifying the temporal order of co-occurrence of multiple HRB, how differing conceptualizations of socio-cultural roles impact on HRB, and health-related effects of HRB co-occurrence. Such information will be useful for maximizing the efficiency and effectiveness of prevention and intervention programs in LMIC.

Prevalence and Predicting Factors of Alcohol Use Among School Going Adolescents in a Hilly State of Northern India

BACKGROUND

Alcohol use among adolescents is rising globally. This habit starts in adolescence and continues throughout their life. Alcohol addiction is associated with many other risky behaviors. Social environmental interventions will be an effective measure to control the problem of alcohol use.

OBJECTIVES

The purpose of this study was to estimate the prevalence of alcohol use among adolescents and to investigate the associated risk and protective factors.

METHODS

A cross-sectional study was carried out among school going adolescents in the hilly state Himachal. A pre-validated, self-administered questionnaire was used for data collection.

RESULTS

The prevalence of alcohol use in adolescent was 6.1% (10.7% in males and 0.4% in females). Binary logistic regression model revealed that parent's and peer's drinking behavior significantly predicts an adolescent's drinking behavior.

CONCLUSION

Our research supports the need for an adolescent health program involving school, peers, and family. Life skill education should be given to the adolescents to inculcate the resilience so that they learn to say no to peers who try to pull them into such habits.

Illicit Drug Use Pattern, Health-Risk Behaviors, and Social Contexts Among Indonesian Students

Health-risk behaviors (smoking, alcohol consumption, and premarital sex) among Indonesian students are important issues. Understanding the association of these health-risk behaviors and adolescents’ social contexts (family, peers, and neighborhood characteristics) to illicit drug use is required to develop strategies in preventing illicit drug use in Indonesia. The study used a multi-stage cluster random sampling method to collect data from the 2016 National Narcotics Survey of Indonesian students. The sample included 31,439 students. The result shows that the illicit drug use pattern was different from previous studies: the most prevalent was at the senior high school level. Multiple logistic regression analyses showed that smoking, alcohol consumption, premarital sex, peers, sex, family, and neighborhood were associated with illicit drug use. The study highlighted the importance of health-risk behaviors, social contexts of adolescents, and the illicit drug use pattern as considering factors in developing strategies to reduce illicit drug use prevalence.

Cluster analysis of risky behaviors among the youth in Western Iran: Determining correlates and comparing clusters based on severity of disability and attitude toward mental health help-seeking

BACKGROUND AND AIMS

The objectives of the study were (i) cluster analysis of risky behaviors; (ii) determining correlates; and (iii) comparing clusters with regard to the attitude toward mental health help seeking.

METHODS

The current cross-sectional study is a part of the first phase of the Persian Youth Cohort. From October 2014 to January 2017, 2990 individuals from Ravansar City in western Iran completed structured interviews and national and international standard questionnaires. The obtained data were analyzed using two-stage cluster analysis, multinomial logistic regression analysis, and Chi-square test.

RESULTS

This model provided three distinct clusters: (i) low-risk group with mild distress, (ii) high-risk group with high distress, and (iii) violent group with medium distress. Some sociodemographic and lifetime psychiatric disorders were the correlates of unhealthy clusters (P < 0.05). Compared to the reference cluster, a higher number of members in unhealthy clusters were suffering from medium to severe disability. Nevertheless, the participants in these clusters were less inclined to mental health help seeking.

CONCLUSIONS

More than half of the youth were suffering from suicidal and violent behaviors. Since high-risk participants are less inclined to mental health help seeking, the health policymakers can successfully utilize the results in planning general health programs.

Knowledge of and attitudes towards abortion among adolescents in Lao PDR

Background

Adolescents are at high risk of unintended pregnancy and consequent unsafe abortion. Evidence from Lao PDR suggests a high but underreported prevalence of induced abortion, especially amongst adolescents. Research suggests adolescents are less likely to have an unsafe abortion when they have accurate knowledge about abortion and hold positive attitudes towards abortion.

Objective

The purpose of this study was to investigate awareness and attitudes towards abortion and associated factors in Lao PDR.

Methods

This study used a descriptive, cross-sectional design. The study was conducted between January and May 2019 in two different provinces within Lao PDR, namely, Khammouane and Champasack provinces. Participants included in- and out-of-school male and female adolescents (n = 800). Data were collected using a structured questionnaire and entered into the EPI Data version 3.1. All analysis was undertaken using STATA v.13. Univariate analysis and frequency distributions were used to study the pattern of responses and bivariate descriptive analysis to report attitudes and knowledge by participant characteristics. The association between participant characteristics and overall scores of attitudes towards abortion was evaluated using multiple logistic regression.

Findings

Most respondents (78.8%) were aware of the processes and potential consequences of becoming pregnant at a young age. One-third of respondents (31.5%), were aware of induced abortion. Of those, only 12.1% held positive attitudes towards induced abortion. Factors associated with positive attitudes towards abortion were ethnicity, mother’s education and ever having had sex.

Conclusion

In the case of unintended or unwanted pregnancy, adolescents must also have adequate knowledge and access to safe abortion and associated counselling services. This study suggests a need to increase sexual and reproductive health literacy including information about safe abortion. This requires a holistic approach to sexual education and needs the support and involvement of adolescents themselves as well as parents, community members and healthcare workers.

Factors influencing sexual and reproductive health among adolescents in Lao PDR

Background

Adolescents are particularly vulnerable to poor sexual and reproductive health outcomes. In addition, Lao PDR has the highest teenage pregnancy rate in southeast Asia and a high maternal mortality ratio.

Objective

This study aimed to provide a comprehensive exploration of factors that influence SRH knowledge, attitudes, and practices of adolescents in Bokeo Province, Lao PDR.

Method

Data from the Adolescent Girl Situation Analysis cross-sectional study, collected in 2018 using a mixed-method approach with 837 adolescents aged 10–19, and key informant interviews, were analysed. Regression analyses were used to identify predictors of modern contraception knowledge, autonomy, gender-based violence, sexual activity, and contraception use. This was complemented with qualitative thematic content analysis.

Results

Adolescents living in two rural districts had lower sexual and reproductive health knowledge compared to urban district residents. Findings showed misconceptions about the birth control pill, a belief that sex education is important, but that the current teaching quality is problematic. There was a strong positive association between knowledge and autonomy. In the two rural districts, residents were more likely to lack autonomy. Marriage was described as an autonomous decision, yet 40.4% lacked autonomy regarding marriage. Among sexually active adolescents, 35.2% used contraception. Boys and girls were said to be equal, yet education access and gender roles favoured boys. Additionally, violence was more justified by husbands against their wives.

Conclusion

The study helps to understand the views and perceptions of adolescents and key informants on gender equality and gender-based violence. Three main areas require more effort and greater investment to improve adolescent sexual and reproductive health: knowledge and use of contraceptives, gender inequality, and autonomy. There is poor knowledge of contraceptive methods, indicating a need to further integrate comprehensive sexual education, introduced in primary school, and to increase investment in training and monitoring teachers.

Beyond Their HIV Status: the Occurrence of Multiple Health Risk Behavior Among Adolescents from a Rural Setting of Sub-Saharan Africa

Background

Health risk behaviors during adolescence may cluster into patterns that might be predicted by specific factors, among which HIV may have an important role.

Method

In a cross-sectional study conducted between 2017 and 2018, clustering of HRB and its associated factors was investigated in rural Kenya among 588 adolescents (36% perinatally HIV infected; 28% perinatally HIV exposed but uninfected; and 36% HIV unexposed/uninfected). Latent class analysis of 22 behaviors followed by multinomial logistic regression were conducted. Four risk behavior classes were identified.

Results

No significant differences were found in behavioral class membership across the three HIV groups (p = 0.366). The risk of membership to the higher risk behavioral classes relative to class 1 (the substance and drug abstinent low risk takers) increased with older adolescent age (p = 0.047), increased among adolescent who experienced mental distress (p < 0.001), and those who felt unsafe in their neighborhood (p < 0.002). Better working memory (p = 0.0037) was found to be protective.

Conclusion

The results highlight a need to include screening and interventions for internalizing mental health problems and deficits in executive functioning, as well as steps to involve family members and communities to address psychosocial risk factors in adolescents in Kenya.

How are depression and suicidal ideation associated with multiple health risk behaviours among adolescents? A secondary data analysis using the 2016 Korea Youth Risk Behavior Web-based Survey

WHAT IS KNOWN ON THE SUBJECT?: Adolescents who partake in one health risk behaviour (HRB) easily adopt other HRBs, simultaneously or subsequently. Multiple HRBs might threaten adolescents' future health in adulthood. Adolescents with psychological problems have higher rates of smoking, alcohol use, early sexual initiation and activity, and illicit substance use compared with others. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: A considerable number of Korean adolescents with mental health problems were engaged in multiple HRBs. For those with mental health problems, more than half of the Korean adolescents with multiple HRBs tended to use alcohol and cigarettes concurrently. Korean adolescents who felt depressed and had suicidal ideation were more likely to engage in a greater number of HRBs. Substance abuse is the most prevalent problem that is combined with other HRBs among those with depression and suicidal ideation compared to those who exhibited other HRBs. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: When mental health nurses working in schools and community centres for mental health identify Korean adolescents with significant depression and suicide ideation levels, they should also assess adolescents' engagement in multiple HRBs. Population-based campaigns and policy changes that emphasize both psychological health and risky behaviour reduction among adolescents should be provided simultaneously to students and school nurses. ABSTRACT: Introduction There is limited understanding about whether poor mental health is associated with certain combinations of multiple health risk behaviours (HRBs) such as smoking, drinking, early sexual activity and substance abuse. Aim To determine the prevalence of multiple HRBs and to identify associations between poor mental health and multiple HRBs as the number of HRBs increases. Methods This cross-sectional study was conducted using the 2016 Korea Youth Risk Behavior Web-based Survey (N = 65,528). Descriptive statistics and multinomial logistic regression analyses were conducted using the complex sample data. Results Overall, 28.6% and 13.9% of Korean adolescents were involved in one or multiple HRBs, respectively. Adolescents who were depressed (OR = 1.43-4.47, 95% CI = 1.37-1.49 to 3.23-6.20) and/or who had suicidal ideation (OR = 1.33-3.19, 95% CI = 1.25-1.42 to 2.25-4.51) were more likely to engage in multiple HRBs. Discussion A considerable numbers of Korean adolescents are engaged in multiple HRBs. When adolescents self-reported depression and suicidal ideation, they were more likely to engage in a greater number of HRBs than single HRB. Implications for practice Tailored interventions to decrease multiple HRBs should be designed and provided by considering adolescents' mental health status and needs.

Psychometric evaluation of drinking refusal self-efficacy questionnaire-shortened revised adolescent in Laos

This study evaluated the psychometric properties of Lao version of Drinking Refusal Self-Efficacy Questionnaire-Shortened Revised Adolescent (L-DRSEQ-SRA). A total of 406 Laotian adolescents from six lower secondary schools, were randomly selected for the evaluation of the following psychometric properties. The original factor model was confirmed via confirmatory factor analysis in Lao adolescents, the convergent and discriminant validity were found appropriate. The mean score of L-DRSEQ-SRA in the non-drinking group was significantly higher than in the drinking group. The L-DRSEQ-SRA showed acceptable internal consistency and test-retest reliability. The psychometric characteristics of the L-DRSEQ-SRA were established throughout this study.

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

OBJECTIVES

The study aimed to assess the prevalence and correlates of sexual risk behaviours among adolescents in four Southeast Asian countries.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Cigarette Smoking Among Secondary School-Going Male Adolescents in Malaysia: Findings From the National Health and Morbidity Survey 2017

Smoking is a learned behavior during adolescence, and it is found predominantly among male adolescents in Malaysia. Our study aimed to investigate the prevalence and predictive factors of current cigarette smoking among school-going male adolescents in Malaysia. Data were derived from the National Health and Morbidity Survey: Adolescent Health Survey 2017, a cross-sectional study that utilized a 2-stage stratified cluster sampling to select a nationally representative sample of school-going adolescents in Malaysia (n = 27 497). Multiple logistic regression analysis was performed to identify factors associated with current cigarette smoking among male adolescents in Malaysia. Male adolescents aged 16 to 17 years (adjusted odds ratio [AOR] = 1.55; 95% confidence interval [CI] = 1.41-1.70), current illicit drug users (AOR = 8.14; 95% CI = 6.37-10.41), current alcohol users (AOR = 1.92; 95% CI = 1.65-2.23), those from rural schools (AOR = 1.60; 95% CI = 1.46-1.76), those whose parents were widowed/divorced/separated (AOR = 1.37; 95% CI = 1.21-1.55), and those whose parents/guardians were tobacco product users (AOR = 3.47; 95% CI = 2.33-5.16) were more likely to be current cigarette smokers. Tobacco control strategies should be aimed at both adolescents at risk and at promoting parental smoking cessation.

Risky Behaviors and Sensation-Seeking in Adolescence: A Descriptive Correlational Study

Risky behaviors are common in developing countries, especially in adolescence. Moreover, sensation seeking is an important factor in personality. This study was conducted to evaluate the relationship between risky behaviors and sensation-seeking in a sample of Iranian adolescents. This study used a cross-sectional method with 400 high school adolescents (age between 15 and 21 years old) in Kashan city from multistage random sampling. The research instrument consisted of three parts: a socio-demographic questionnaire, the Youth Risk Behavior Surveillance System (YRBSS) and the Zuckerman Sensation-Seeking Scale-V (SSS-V). Data analysis was performed using the t-test, ANOVA, chi-square, regression and Spearman correlation coefficient in SPSS v 11.5. Risky behaviors were found in 51.2% of students, and a significant difference was found between the male and female students in this regard (p < .021). The overall sensation-seeking score and the scores in the dimensions of experience seeking, disinhibition, and boredom susceptibility were higher in males than females (p < .0001). All dimensions of sensation-seeking other than disinhibition dimension could significantly predict risky behavior. Sensation seeking can be used as an indicator for screening risky behaviors. Detailed planning on the part of the health care system and public authorities is recommended for appropriate screening and counseling adolescents with risky behaviors.

The relationships between sexual risk behaviors and general health risk behaviors among unmarried youth in Thailand

Objectives:

The prevalence and correlates of sexual risk behaviors among unmarried youth in Thailand are poorly documented. The objectives of this study were to compare the differences in sexual behaviors across age groups and gender and to identify the relationships between sexual risk behaviors and general health risk behaviors among unmarried Thai youth.

Methods:

A population-based, nationally representative, cross-sectional survey was conducted between January and March 2013. The Thai version of the Youth Risk Behavior Survey questionnaire was used to collect data from 800 unmarried Thai youth.

Results:

Majority of the respondents (65.9%) had not engaged in any sexual risk behavior, 18.7% had engaged in 2–3 sexual risk behaviors, and only 5.5% had engaged in a single sexual risk behavior. Current sexually active youth had higher risk of participating in physical fights (odds ratio = 3.41, 95% confidence interval = 1.53–7.57), smoking cigarette (odds ratio = 4.05, 95% confidence interval = 1.89–8.67), and drinking alcohol (odds ratio = 2.17, 95% confidence interval = 1.08–4.36).

Conclusion:

Thai youth were more likely to be involved in multiple sexual risk behaviors than a single sexual risk behavior. Physical fighting was the strongest general health risk behavior associated with the sexual risk behaviors, followed by substance abuse.

Clusters of alcohol and drug use and other health-risk behaviors among Thai secondary school students: a latent class analysis

Background

Alcohol and drug use and other health-risk behaviors tend to cluster together among adolescents and contribute a large amount of harm to both themselves and to others. This paper aims to characterize secondary school students based on their clusters of health-risk behaviors and identify factors determining class membership to these behavior-clusters.

Methods

Data from a national school survey was used to identify clusters of alcohol and drug use and other health-risk behaviors among secondary school students aged 12–15 years using a latent class regression model. A multinomial logistic regression model was used to identify predictors of the cluster membership.

Results

A total of 25,566 students were included in the analysis, of which 88% were classified as having low-risk behaviors reporting only moderate alcohol use; 11% as having moderate-risk behaviors, such as driving under the influence of alcohol, fighting, carrying a weapon, and alcohol and tobacco use; and 0.6% as having high-risk behaviors, such as use of illicit drugs, particularly kratom and cannabis. Males, older students, those with a poor school performance, not living with parents, drug use by family members and peers, and having a low level of perceived disdain from their friends if they used drugs were significant risk factors for being in the moderate- and high-risk behavior classes.

Conclusions

Alcohol, tobacco and drug use, as well as other health-risk behaviors such as fighting, are clustered in Thai secondary school students. This result highlights the importance of comprehensive prevention and education strategies, particularly for moderate to high-risk groups.

Perspectives on Underlying Factors for Unhealthy Diet and Sedentary Lifestyle of Adolescents at a Kenyan Coastal Setting

Unhealthy diet and physical inactivity are among the key modifiable risk factors for non-communicable diseases, such as diabetes and cardiovascular disease. Although such diseases often only appear in adulthood, these behaviors are typically initiated or reinforced already during adolescence. However, knowledge on underlying factors for adolescents' unhealthy dieting and physical inactivity in sub-Saharan Africa (SSA) is poor. We conducted in-depth interviews and focus group discussions to explore the perceptions of a diverse group of 78 young people of 10-19 years of age, which also included some adolescents living with HIV, as this is an emerging group in the HIV/AIDS epidemic in many parts of SSA. In addition, 10 stakeholders, such as teachers, clinicians, and staff from organizations at the Kenyan coast and seven young adult community representatives informed us on: (a) adolescents' unhealthy food choices and their forms of sedentary behavior; (b) predisposing factors; and (c) protective factors against unhealthy food choices and sedentary behavior of adolescents living in Kilifi County. The findings reveal that adolescents occasionally access nutritious foods, such as fruits, vegetables, and animal protein. However, there is a growing tendency to consume unbalanced diets with high intake of carbohydrates, oily foods, and consumption of sugar dense processed foods and drinks. Sports and domestic chores were found to be major sources of physical activity. Sedentary lifestyles characterized by a long-time sitting and chatting, watching sports games and movies were described. Adolescents living with HIV did not indicate any divergent perceptions from those of other adolescents relating to diet and physical activity, but mentioned health-related conditions, such as medication, asthma, and low body weight, as a risk factors for sedentary lifestyle. Using a Socio-Ecological model, our findings suggest that risk factors are numerous and interrelated, especially at intrapersonal, interpersonal, and community level. The negative influences at an intrapersonal level were as follows: body image concerns, attitudes and misconceptions, substance use behavior, and taste for unhealthy foods. In the interpersonal domain, household poverty and parenting practices that condone unhealthy habits were identified risk factors. Availability of affordable unhealthy foods, high prices for nutritious food, farming practices, gambling, and influx of transportation alternatives in the community were interrelated but also had relationships with intrapersonal and interpersonal risk factors. Modernization and poor implementation of policies were discussed as enabling factors especially by stakeholders from a societal perspective. Seasonality and farming practices, school attendance, community-based services, and regulations mitigating adolescents' engagement in gambling were identified as potential protective factors. Our findings provide a unique qualitative insight of the factors underlying adolescents' dietary and sedentary lifestyle and highlight the need for ecological intervention approaches to address these forms of health risk behavior in a rural African setting.

Simultaneous Health Risk Behaviors in Adolescents Associated with Higher Economic Class in the Northeast of Brazil

DESIGN

The social, cultural, and economic context can be an important variable in the perception and adoption of risk behaviors in adolescents.

OBJECTIVE

The purpose of this study was to identify the prevalence of simultaneous health risk behaviors and associated socioeconomic factors in adolescents living in the metropolitan region of Aracaju, State of Sergipe, Brazil.

METHODS

The sample consisted of 2,207 high school students aged 13-18 years. The risk behaviors measured were "low levels of physical activity," "excessive daily TV time," "high consumption of alcoholic beverages on a single occasion," "involvement in fights," "smoking cigarettes," "carrying firearms," and "marijuana consumption." Information was obtained through self-administered questionnaire.

RESULTS

Considering the results, it was observed that female adolescents and those aged up to 16 years were less likely to have two or more health risk behaviors compared to males and those aged 17 years or more, respectively. It was also found that both high- and middle-income level adolescents had higher prevalence of having two or more health risk behaviors.

CONCLUSIONS

It was concluded that male adolescents older than 16 years with better socioeconomic level were more exposed to the simultaneous presence of several health risk behaviors.

The prevalences of and association between nonmedical prescription opioid use and poor sleep among Chinese high school students

The purpose of this study was to investigate the prevalences of and association between nonmedical prescription opioid use (NMPOU) and sleep quality among Chinese high school students. A cross-sectional study was conducted in Chongqing high school students in 2012, and questionnaires from 18,686 students were completed and eligible for this study. Demographic and NMPOU information was collected using a self-administered questionnaire. The Chinese Pittsburgh Sleep Quality index (CPSQI) was used to assess the occurrence of poor sleep. Among the total sample, 18.0% were classified as poor sleepers (27.4% of the subjects with past-month NMPOU), and the prevalences of lifetime, past-year and past-month NMPOU were 14.6, 4.6 and 2.8% across the entire sample, respectively. The most commonly used medicine was licorice tablets with morphine (9.1, 2.5 and 1.5% for lifetime, past-year and past-month, respectively), followed by cough syrup with codeine, Percocet, diphenoxylate and tramadol. After adjustment for potential confounders, the association between past-month NMPOU and poor sleep remained significant (AOR = 1.47, 95% CI 1.17 to 1.85). Programs aimed at decreasing NMPOU should also pay attention to sleep quality among adolescents.

Multiple risk behaviors for non-communicable diseases and associated factors in adolescents

Objective: To estimate the prevalence of risk behaviors for non-communicable diseases and analyze their associated factors in adolescents. Methods: A school-based cross-sectional study was conducted in 2008 with 1,139 adolescents aged 14 to 19 years attending public and private high schools in Cuiabá, Midwestern Brazil. Data were collected using a selfadministered questionnaire, including a semiquantitative Food Frequency Questionnaire. The prevalence of tobacco smoking, alcohol experimentation, physical inactivity, unsatisfactory meal pattern, and excessive intake of saturated fat and sodium were evaluated. The associations between risk behaviors and socioeconomic variables, weight status, and self-perceived health status were evaluated. Results: The most common risk behaviors were excessive sodium intake (88%), unsatisfactory meal pattern (72%), excessive intake of saturated fat (39%), and alcohol experimentation (39%). Four of 10 adolescents were exposed to two risk behaviors simultaneously. Among male adolescents, the main factors associated with risk behaviors were: type of school, class schedule, education level of the household head, weight status, and self-perceived health status. Among female adolescents, age, type of school, class schedule, and education level of the household head were the main factors associated with risk behaviors. Conclusion: The prevalence of exposure to risk behaviors for non-communicable diseases was high, highlighting the simultaneous presence of tobacco smoking and experimentation of alcoholic beverages. Special attention should be given to educational activities to minimize the effects of the simultaneous occurrence of multiple risk behaviors.

Growth Trajectories of Health Behaviors from Adolescence through Young Adulthood

Based on nine waves of data collected during a period of 17 years (1990-2007), the present study explored different developmental trajectories of the following unhealthy behaviors: regular smoking, lack of regular exercise, lack of daily fruit intake, and drunkenness. A baseline sample of 1195 13-year-old pupils was from 22 randomly selected schools in the Hordaland County in western Norway. Latent class growth analysis revealed three developmental trajectories. The first trajectory was a conventional trajectory, comprising 36.3% of participants, who showed changes in smoking, physical exercise, fruit intake, and drunkenness consistent with the prevailing age specific norms of these behaviors in the Norwegian society at the time. The second trajectory was a passive trajectory, comprising 25.5% of participants, who reported low levels of both healthy and unhealthy behaviors during the 17-year period. The third trajectory was an unhealthy trajectory, comprising 38.2% of participants, who had high levels of unhealthy behaviors over time. Several covariates were examined, but only sex and mother's and father's educational levels were found to be significantly associated with the identified trajectories. While these findings need to be replicated in future studies, the identification of the different trajectories suggests the need to tailor intervention according to specific needs.

Depressive symptoms and clustering of risk behaviours among adolescents and young adults attending vocational education: a cross-sectional study

Background

Depressive symptoms and risk behaviours often do not occur in isolation among adolescents and young adults. In order to improve intervention programmes, more research is needed to elucidate the clustering of risk behaviours, the association with depressive symptoms, and demographic variables. Therefore, this study examined the clustering of risk behaviours, the association with depressive symptoms, and demographic variables among adolescents and young adults in vocational education. Furthermore, the prevalence of depressive symptoms and risk behaviours was examined.

Methods

This study included 584 students (mean age 18.3 years) attending vocational education in the Netherlands. Depressive symptoms and risk behaviours (binge drinking, cannabis use, smoking, delinquency and incurring debts) were assessed with self-report questionnaires. Truancy was monitored via the school registration system. Principal Components Analysis (PCA) was conducted to assess the factor structure of the risk behaviours (i.e. clustering). Linear regression analyses with a bootstrapping method were performed to assess the associations.

Results

Binge drinking was reported by 50.5% and cannabis use by 14.2% of the students (both in the past 4 weeks), whereas 37.7% reported currently being a smoker. More than 10% reported having been questioned at a police station in the past year. Furthermore, 82.2% had been truanting in the first two months of education, 21.0% reported having debts and 29.2% reported clinically-relevant depressive symptoms. The PCA indicated two clusters. The ‘substance use’ cluster consisted of the risk behaviours: binge drinking, cannabis use and smoking. The ‘problem behaviours’ cluster consisted of the risk behaviours: delinquency, truancy and incurring debts. Both clusters were associated with depressive symptoms. Various demographic variables were associated with both clusters.

Conclusions

Risk behaviours formed two clusters, both of which were associated with depressive symptoms. These findings underscore the importance of screening adolescents and young adults at lower educational levels for multiple risk behaviours and depressive symptoms and of focusing on multiple risk behaviours in interventions simultaneously.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1692-7) contains supplementary material, which is available to authorized users.

Demographic and socio-economic factors associated with multiple health risk behaviours among adolescents in Serbia: a cross sectional study

BACKGROUND

The aim of this study was to examine the relationships between demographic and socioeconomic characteristics and engaging in multiple risk behaviours among adolescents in Republic of Serbia.

METHODS

This study presents a cross sectional study of 683 adolescents aged 15 to 19 attending high school. The database from the 2006 National Health Survey was used. As a measure of demographic and socio-economic characteristics: age, type of settlement, family structure, having one's own room, school success and the household wealth index were used. Multivariate logistic regression model was performed.

RESULTS

Boys were more than twice as likely to engage in multiple risk behaviours than girls. Adolescents who were older (OR = 5.82, 95% CI = 3.21-10.54, boys; OR = 3.76, 95% CI =1.77-7.99, girls) and adolescents who achieved low or moderate (OR = 1.82, 95% CI = 1.02-3.26, boys; OR = 3.36, 95% CI =1.51-7.44, girls) school success had significantly higher risk than younger ones and those with high school success. Also, boys who came from a richer class households (OR = 3.14, 95% CI =1.02-9.66) and girls from incomplete family (OR = 5.07, 95% CI = 2.06-12.50) had higher risk than boys from the poorest households and girls from complete family.

CONCLUSIONS

Further preventive interventions in Serbia should be gender and age specific, oriented towards older adolescents, those who have low or moderate school success, boys from richer class households and girls who live in incomplete families.

Prevalence, Comorbidities, and Cofactors Associated With Alcohol Consumption Among School-Going Adolescents in Malaysia

Alcohol is deleterious to physical and mental health as well as social well-being. This study aims to examine the prevalence of alcohol consumption and factors associated with its use among school-going Malaysian adolescents. The Global School-Based Student Health Survey (GSHS) 2012 employed 2-stage clustering design to Malaysian secondary school respondents aged 12 to 17 years. The prevalence of current alcohol usage was 8.9% (95% confidence interval [CI]: 7.8-10.07) overall, 11.2% (95% CI: 9.80-12.80) among males, and 23.4 (95% CI: 21.40-25.50) among Chinese students. Multivariate logistic regression showed that adolescents who had used alcohol were more likely to have used substance (adjusted odds ratio [aOR] = 3.39; 95% CI: 2.33-4.99), experienced injury (aOR = 1.53; 95% CI: 1.20-1.95), and engaged in sexual behaviors (aOR = 1.42, 95% CI: 1.12-1.79), and fights (aOR = 1.23; 95% CI: 1.08-1.41). The current national policies on alcohol should be strengthened to curb alcohol consumption among adolescents.

Multiple risk behaviour in adolescence and socio-economic status: findings from a UK birth cohort

BACKGROUND

Patterns of risk behaviour during teenage years may vary by socio-economic status (SES). We aimed to examine possible associations between individual and multiple risk behaviours and three measures of SES in mid-adolescence.

METHODS

The sample (n = 6406) comprised participants from the Avon Longitudinal Study of Parents and Children, a UK birth cohort. Thirteen risk behaviours spanning sexual health, substance use, self-harm, vehicle-related injury, criminality and physical inactivity were assessed in mid-adolescence (age 15-16 years). Associations between three measures of SES (maternal education, household income and parental social class) and (i) individual risk behaviours and (ii) the total number of risk behaviours were examined.

RESULTS

For a one-category reduction in social class, maternal education or income, the odds of having a greater number of multiple risk behaviours increased by 22, 15 and 12%, respectively. At the individual level, there was evidence of a strong relationship with decreasing SES across all three measures of SES and criminality, car passenger risk, TV viewing, scooter risk, early sexual behaviour and weekly tobacco use but insufficient evidence of a relationship for physical inactivity, cycling without a helmet and illicit substance use. There was weak evidence of association between SES and hazardous drinking, self-harm, cannabis use and unprotected sex, but this was not consistent across the SES measures.

CONCLUSION

The association between multiple risk behaviours and SES suggests that prevention strategies should apply the principal of proportionate universalism with a focus on more deprived populations, within a population-wide strategy, to prevent widening of social inequalities.

Predictors of premarital sexual activity among unmarried youth in Vientiane, Lao PDR: the role of parent-youth interactions and peer influence

Research indicates that adolescents in low-income countries have an early sexual debut and engage in risky sexual behaviours. Few studies in low-income countries however, have explored the factors that influence young people's sexual behaviours. This study examined individual, family and peer-level factors associated with premarital sexual behaviours in the Lao People's Democratic Republic (PDR). A cross-sectional survey was undertaken with unmarried youth aged 18 to 24 years (N = 1200) in Vientiane Capital City. Logistic regression models, controlling for confounding variables, were employed to test for the contribution of factors influencing premarital sexual activity. Most respondents held positive attitudes towards premarital sex, with males having more liberal attitudes than females (mean score of 2.68 vs. 2.32, p < 0.001). Prevalence of premarital sexual activity was higher among males than females (44.7% and 19.2%, respectively). Predictors of premarital sex for males were age, sexual attitudes, perceived parental expectations regarding sex, dating and peer influence. For females, predictors were father's level of education, parent-youth sexual communication, peer influence and liberal sexual attitudes. The results highlight the role of parent-youth interaction and peer influence. The results suggest the need for a range of strategies at the individual, peer and family level, as well as a gender-specific focus.

Strengthening the enabling environment for women and girls: what is the evidence in social and structural approaches in the HIV response?

There is growing interest in expanding public health approaches that address social and structural drivers that affect the environment in which behaviour occurs. Half of those living with HIV infection are women. The sociocultural and political environment in which women live can enable or inhibit their ability to protect themselves from acquiring HIV. This paper examines the evidence related to six key social and structural drivers of HIV for women: transforming gender norms; addressing violence against women; transforming legal norms to empower women; promoting women's employment, income and livelihood opportunities; advancing education for girls and reducing stigma and discrimination. The paper reviews the evidence for successful and promising social and structural interventions related to each driver. This analysis contains peer-reviewed published research and study reports with clear and transparent data on the effectiveness of interventions. Structural interventions to address these key social and structural drivers have led to increasing HIV-protective behaviours, creating more gender-equitable relationships and decreasing violence, improving services for women, increasing widows' ability to cope with HIV and reducing behaviour that increases HIV risk, particularly among young people.

Risk perceptions of STIs/HIV and sexual risk behaviours among sexually experienced adolescents in the northern part of Lao PDR

BACKGROUND

Young people in Laos are more vulnerable to STIs/HIV due to their sexual risk behaviours, low perceptions of risk and their socio-cultural environments. Perceived risk of contracting STIs/HIV is crucial for the assessment of their risk regarding their actual sexual risk behaviors. Thus, the objective of this paper is to explore perceptions of risk related to STIs/HIV and identify factors associated with this perceived risk among adolescents.

METHODS

This was a cross sectional study of sexually experienced adolescents aged 14 to 19 years old in the Luangnamtha province. The multistage sampling techniques were used for selecting 1008 adolescents aged 14-19 years old. Of these, 483 respondents reported having had sexual experience was selected for analysis. Univariate and Logistic regression were performed.

RESULT

Six per cent of respondents reported ever having had anal sex. Slightly less than two thirds initiated their first sexual intercourse before age 15. Two thirds of the sexually experienced males reported two or more sexual partners during their lifetime with the mean 3.1+3.65 while only twelve per cent of girls reported this cumulative number of partners. Slightly more than half (57.6%) regarded themselves to have no risk at all with 17.2 per cent considered themselves to have low risk. Respondents had poor knowledge on STIs/HIV. Factors associated with risk perception of getting STIs were: being male, high level of knowledge about STIs and having had symptoms of STIs in last six months. Perceived risk of getting HIV was significantly associated with being male, having more knowledge about STIs and HIV.

CONCLUSION

Adolescents in this study engaged in sexual risk behaviours, but they have low perception of risk getting STI/HIV. Socio-demographic factors, knowledge of STIs/HIV, and the level of exposure to STIs were the main determinants of the risk perception of STIs/HIV. Our finding supports the need to target adolescents in Luangnamtha province for HIV prevention intervention by addressing inaccurate perception of risk and increasing their knowledge on STIs/HIV.

Socio-Structural Barriers, Protective Factors, and HIV Risk Among Central-Asian Female Migrants in Moscow

Objective

This study aimed to build formative knowledge on socio-structural barriers, protective factors, and HIV sexual risk amongst Central-Asian female migrants in Moscow.

Methods

Data collection included ethnographic interviews in Moscow with a purposive sample of 30 unmarried female migrants, 15 from Kyrgyzstan and 15 from Tajikistan.

Results

Study participants reported difficulties with acquiring documents for legal status, financial insecurity, discrimination, sexual harassment, and lack of support. Based on analysis of the cases, one pathway linked lack of legal documentation and instrumental support with elevated sexual risk. Another pathways linked traditional cultural attitudes with both no and moderate sexual risk.

Conclusion

Future HIV prevention efforts with Central Asian female migrants in Moscow should be multilevel and include: increasing HIV and prevention knowledge and skills, promoting condom use with regular partners, identifying and supporting cultural attitudes that protect against HIV sexual risk behaviors, facilitating legal status, building community support, and increasing economic options.

Lazer sedentário e consumo de alimentos entre adolescentes brasileiros: Pesquisa Nacional de Saúde do Escolar (PeNSE), 2009

O objetivo deste trabalho foi investigar se o lazer sedentário está associado a um maior consumo regular de alimentos não saudáveis independentemente de indicadores sociodemográficos e de contexto familiar. A análise envolveu 59.809 escolares da Pesquisa Nacional de Saúde do Escolar (PeNSE) conduzida em 2009. A variável resposta foi o lazer sedentário, definido como o tempo diário em frente à TV superior a duas horas/dia. As variáveis explicativas de interesse foram o consumo regular de refrigerantes, guloseimas, biscoitos doces e embutidos. Odds ratios (OR) e intervalos de 95% de confiança (IC95%) foram obtidos por regressão logística múltipla. A prevalência de lazer sedentário foi de 65%. O consumo regular de alimentos não saudáveis foi estatisticamente maior entre os que relataram lazer sedentário, antes e após ajuste por sexo, idade, cor da pele autorreferida, dependência administrativa da escola, índice de bens no domicílio e composição familiar. Esses resultados apontam a necessidade de intervenções que promovam, de forma integrada, lazer e dieta saudável entre os jovens.

Risky music-listening behaviors and associated health-risk behaviors

OBJECTIVE

To examine, among adolescents and emerging adults attending inner-city lower education, associations between risky music-listening behaviors (from MP3 players and in discotheques and at pop concerts) and more traditional health-risk behaviors: substance use (cigarettes, alcohol, cannabis, and hard drugs) and unsafe sexual intercourse.

METHODS

A total of 944 students in Dutch inner-city senior-secondary vocational schools completed questionnaires about their music-listening and traditional health-risk behaviors. Multiple logistic regression analyses were used to examine associations between music-listening and traditional health-risk behaviors.

RESULTS

Risky MP3-player listeners used cannabis more often during the past 4 weeks. Students exposed to risky sound levels during discotheque and pop concert attendance used cannabis less often during the past 4 weeks, were more often binge drinkers, and reported inconsistent condom use during sexual intercourse.

CONCLUSIONS

The coexistence of risky music-listening behaviors with other health-risk behaviors provides evidence in support of the integration of risky music-listening behaviors within research on and programs aimed at reducing more traditional health-risk behaviors, such as substance abuse and unsafe sexual intercourse.

Association between binge drinking, type of friends and gender: a cross-sectional study among Brazilian adolescents

BACKGROUND

Hazardous drinking among adolescents is a major public health concern. The purpose of this study was to examine the prevalence of binge drinking/alcohol consumption and its association with different types of friendship networks, gender and socioeconomic status among students in Belo Horizonte, Minas Gerais, Brazil.

METHODS

We conducted a cross-sectional study on a representative random sample of 891 adolescents (41% male, aged 15-19 years) from public and private schools in 2009-2010. Information on friendship networks and binge drinking was collected using two validated self-administered questionnaires: the Integrated Questionnaire for the Measurement of Social Capital and the first 3 items in the Alcohol Use Disorders Identification Test (AUDIT C). We used the area-based Social Vulnerability Index (SVI), mother and father's educational background, and the type of school to assess socioeconomic status. The chi-squared test was used to examine the associations between sample characteristics or the type of friends and binge drinking (p-values <0.05 were considered statistically significant). Ordinal logistic regression was used to estimate the association between binge drinking and the independent variables.

RESULTS

A total of 321 (36%) adolescents reported binge drinking (5 or more drinks in one occasion), and among them, 233 (26.2%) adolescents reported binge drinking less than monthly to monthly, and 88 (9.9%) weekly to daily. Binge drinking was associated with being male (OR = 1.52, 95% CI 1.01-2.28) and with living in a low vulnerability area (having the best housing conditions, schooling, income, jobs, legal assistance and health) (OR = 1.66, 95% CI 1.05-2.62). Students who reported that their closest friends were from school (as opposed to friends from church) had an increased risk of binge drinking (OR = 3.55, 95% CI 1.91-5.87). In analyses stratified by gender, the association was significant only among the female students.

CONCLUSIONS

The prevalence of binge drinking was high in this sample of Brazilian adolescents, and gender, low social vulnerability and friendship network were associated with binge drinking.

Multiple health behaviours: overview and implications

BACKGROUND

More remains unknown than known about how to optimize multiple health behaviour change.

METHODS

After reviewing the prevalence and comorbidities among major chronic disease risk behaviours for adults and youth, we consider the origins and applicability of high-risk and population strategies to foster multiple health behaviour change.

RESULTS

Findings indicate that health risk behaviours are prevalent, increase with age and co-occur as risk behaviour clusters or bundles.

CONCLUSIONS

We conclude that both population and high-risk strategies for health behaviour intervention are warranted, potentially synergistic and need intervention design that accounts for substitute and complementary relationships among bundled health behaviours. To maximize positive public health impact, a pressing need exists for bodies of basic and translational science that explain health behaviour bundling. Also needed is applied science that elucidates the following: (1) the optimal number of behaviours to intervene upon; (2) how target behaviours are best selected (e.g. greatest health impact; patient preference or positive effect on bundled behaviours); (3) whether to increase healthy or decrease unhealthy behaviours; (4) whether to intervene on health behaviours simultaneously or sequentially and (5) how to achieve positive synergies across individual-, group- and population-level intervention approaches.

Condutas de risco à saúde e indicadores de estresse psicossocial em adolescentes estudantes do Ensino Médio

O objetivo deste artigo foi analisar a associação entre condutas de risco à saúde (tabagismo, consumo de bebidas alcoólicas e uso de drogas) e indicadores de estresse psicossocial em adolescentes estudantes do ensino médio. A pesquisa foi realizada com amostra constituída por 4.210 adolescentes estudantes de escolas públicas do Estado de Pernambuco, Brasil. O Global School-based Student Health Survey foi usado para coletar dados pessoais (demográficos e socioeconômicos) e comportamentais, e para obter medidas dos indicadores de estresse psicossocial (variáveis desfecho). Foram observadas prevalências de tristeza, sentimento de solidão, pensamento de suicídio, dificuldade para dormir devido à preocupação e planos de suicídio. Tabagismo, consumo de bebidas alcoólicas e uso de drogas foi relatado, respectivamente, por 7,7%, 30,3% e 6,9%. As prevalências de indicadores de estresse psicossocial foram maiores entre as moças, e as prevalências de exposição a condutas de risco à saúde foram maiores entre os rapazes. Concluiu-se com o estudo que o uso de drogas está diretamente associado ao pensamento e plano de suicídio e, entre as moças, o consumo de bebidas alcoólicas foi um fator associado ao estresse psicossocial.