Clustering of health risk behaviors among early adolescents in Taiwan: A latent class analysis

A BSTRACT Objectives: This study had two main objectives. First, it aimed to identify clusters of health risk behaviors (HRBs) among Taiwanese adolescents and then to examine the associations between these behavior clusters and sociodemographic factors, including grade level, sex, and food insecurity, to validate the identified clusters using known-group methods. Second, it explored the relationships between the clusters and health outcomes, including anxiety and obesity. Materials and Methods: This study used data from the 2012, 2014, and 2016 Taiwan Global School-Based Student Health Survey. Latent class analysis (LCA) identified clusters of HRBs: smoking, alcohol use, unhealthy diet, physical inactivity, and sedentary behavior. Latent class regression assessed the associations between cluster membership and sex, grade, and food insecurity to validate the clusters using the known-group method. The associations between clusters and health outcomes (anxiety and obesity) were examined using posterior weighted-probability logistic regression. Results: After excluding invalid responses, 14,757 junior high school students (grades 7–9) were analyzed. LCA identified three clusters: “low-risk” (55.04%), “dietary deficiency” (33.68%), and “high-risk” (11.28%). Females had higher odds of being in the “dietary deficiency” cluster (adjusted odds ratio [AOR] = 1.43) and lower odds in the “high-risk” cluster (AOR = 0.38). A higher grade level was linked to increased odds of “dietary deficiency” (AOR = 1.67 & AOR = 2.67) and “high risk” (AOR = 1.66 & AOR = 2.35). High food insecurity was strongly associated with both “dietary deficiency” (AOR = 2.97) and “high-risk” (AOR = 9.93). Compared with the low-risk cluster, only high-risk cluster was associated with higher odds of anxiety (AOR = 2.4), while no significant association was observed with obesity after adjustment for covariates. Conclusion: This study demonstrates that HRBs among adolescents co-occur, forming three distinct clusters. Because only the “high-risk” group showed a significant association with adverse health outcomes such as anxiety, health programs should focus on high-risk adolescents.