Key result
Clustering of ≥3 unhealthy lifestyle behaviors occurred in 51.5% of adolescents, with odds increased by older age (AOR 1.79) and male sex, but reduced by high family affluence (AOR 0.62).
Why the study?
The clustering of unhealthy lifestyle behaviours and their contextual determinants among adolescents across Europe, Central Asia, and North America had not been fully examined.
Cross-Sectional (n=210,713)
Yes
Over half of adolescents engage in three or more clustered unhealthy lifestyle behaviors, highlighting the need for multisectoral interventions targeting family and school environments.
Clustering of unhealthy behaviors in adolescents may support multi-component prevention; leaves open causal links and practice change pending longitudinal data.
Background: This study examined the clustering of unhealthy lifestyle behaviours and their determinants among adolescents across Europe, Central Asia, and North America. Methods: The study included 210,713 adolescents aged 11 to 15 years from 45 countries who participated in the 2018 Health Behaviour in School-aged Children (HBSC) study. Lifestyle behaviours, including physical inactivity, inadequate fruit and vegetable consumption, frequent soft drink consumption, alcohol use, and smoking, were used to examine the clustering of unhealthy behaviours. Multilevel mixed-effects logistic regression was employed to assess the associations between unhealthy behaviour clustering (≥3 unhealthy behaviours) and contextual factors at the individual, family, and school levels. Results: A high prevalence of clustered unhealthy behaviours was observed among adolescents, with 51.5% engaging in three or more unhealthy lifestyle behaviours. The odds increased with age (AOR: 1.79, 95% CI: 1.75, 1.84 for those aged ≥ 15 years), among males (AOR: 1.26, 95% CI: 123, 1.28), and among those experiencing higher academic pressure (AOR: 1.13, 95% CI: 1.09, 1.17 for very high academic pressure). In contrast, the odds were lower among adolescents from a higher family affluence background (AOR: 0.62 95% CI: 0.60, 0.65 for high), among adolescents living with both parents (AOR: 0.83, 95 CI: 0.81, 0.85), those reporting higher family support (AOR: 0.62, 95% CI: 0.60, 0.63 for high), higher peer support at school (AOR: 0.87, 95% CI: 0.84, 0.89 for high), and those reporting higher school satisfaction (AOR: 0.50, 95% CI: 0.48, 0.52 for very high). Conclusions: The study reveals that one in two adolescents engages in three or more unhealthy lifestyle behaviours. It emphasises the need to tackle this public health challenge through multisectoral interventions targeting individual-level and contextual factors at the family and school levels.
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Efa et al. (2025) conducted a cross-sectional in Unhealthy lifestyle behaviours (n=210,713). Contextual factors (e.g., age, sex, family affluence, school support) vs. Reference groups was evaluated on Clustering of unhealthy behaviours (≥3 unhealthy behaviours). Clustering of ≥3 unhealthy lifestyle behaviors occurred in 51.5% of adolescents, with odds increased by older age (AOR 1.79) and male sex, but reduced by high family affluence (AOR 0.62).
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