Lifestyle Interventions for Multiple Behavioral Risk Factors Among Adolescents in Asia: A Systematic Review of Randomized Controlled Trials

Given the rising prevalence in Asian adolescents who engage in multiple risk behaviors and the lack of a consolidated evaluation of multibehavior intervention outcomes, this systematic review examined the effectiveness of lifestyle interventions targeting two or more of the “Big 6” behavioral risk factors: physical inactivity, excessive sedentary time, poor sleep, unhealthy diet, smoking, and alcohol use. A comprehensive search of seven databases (Public Medline, Embase, Psychological Information Database, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials) identified 28 eligible randomized controlled trials. Of these, 13 demonstrated effectiveness in addressing two or more of the target behaviors, most commonly addressing combinations of physical activity and diet ( n = 5), and physical activity and sedentary behavior ( n = 3). Effective interventions were delivered over 3 to 39 weeks, with weekly durations ranging from 0.5 to 5 h, and all were school-based. Seven interventions incorporated active family involvement, and two included digital components either independently or alongside family engagement. Nine interventions were guided by explicit theoretical frameworks and consistently applied behavior change techniques that provided clear and actionable guidance. The evidence suggests that multibehavior interventions show potential for improving adolescent health behaviors in Asia, particularly when delivered in school settings, supported by families, enhanced through accessible digital technologies, and grounded in theory-based strategies.