Individual and contextual characteristics associated with concurrent risk factors among adolescents: a multilevel cross-sectional study based on the 2019 Brazilian National Health Survey

Abstract Objective To assess the simultaneity of risk behaviors for chronic non-communicable diseases and their association with individual and contextual characteristics in Brazilian adolescents. Methods Cross-sectional study using data from the 2019 Brazilian National Health Survey. The simultaneity of factors of the consumption of ultra-processed foods, level of physical activity, smoking and alcohol use was analyzed, according to individual and contextual characteristics, estimating the odds ratios (OR) and respective 95% confidence intervals (95%CI) for fixed effects and variance and 95%CI for random effects, through multilevel polytomous logistic regression. Results Among the 4,336 adolescents evaluated, the most prevalent combination of two risk behaviors included the consumption of ultra-processed foods and insufficient level of physical activity (13.3%; 95%CI 11.6; 15.3). The most frequent combination of three factors included these behaviors combined with habitual alcohol use (3.6%; 95%CI 2.7; 4.8). The chances of combinations of three or four factors were lower in females (OR 0.44; 95%CI 0.32; 0.60) and in rural areas (OR 0.46; 95%CI 0.31; 0.70) and higher in older adolescents (OR 2.57; 95%CI 1.72; 3.83), with higher levels of education (OR 8.11; 95%CI 2.41; 27.26) and living without partners (OR 3.83; 95%CI 1.10; 13.35). High Human Development Indices increased these chances (OR 7.28; 95%CI 3.81; 13.92), while high Social Vulnerability Indices (OR 0.25; 95%CI 0.11; 0.58) and Gini Indices (OR 0.28; 95%CI 0.15; 0.52) reduced them. Conclusion The occurrence of multiple risk behaviors in adolescents is more likely among older, male, single and more educated adolescents, especially in areas of greater socioeconomic development.