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Abstract :
[en] Introduction
Adolescent risk behaviours such as substance use and sexual risk behaviours often co-occur, yet are rarely studied jointly across countries. This study identified clusters of co-occurring behaviours and examined their distribution across sociodemographic and national contexts.
Methods
Data were drawn from the HBSC 2022 survey, including 82,760 adolescents aged 15 years from 39 countries. Indicators included cigarette smoking, e-cigarette use, alcohol use, drunkenness, cannabis use, early sexual initiation, and protection at last intercourse. Multilevel latent class analysis identified behavioural clusters while accounting for country-level structure. Associations with age, sex, family affluence, GDP, and income inequality were examined.
Results
Five classes emerged: low-risk (57.8%), multiple-risk (10.6%), substance use (21.4%), alcohol-dominant (7.9%), and sexual-risk (2.3%). The multiple-risk class showed high probabilities of cigarette (75.7%), e-cigarette (82.2%), alcohol (99.1%), drunkenness (86.1%), and cannabis use (47.8%), with elevated early sexual initiation (16.0%) and unprotected intercourse (12.8%). The sexual-risk class had the highest early initiation (70.0%) and unprotected intercourse (36.6%).
Four country groups displayed distinct patterns: the low-risk class ranged from 48.7% to 88.1%, while the alcohol-dominant class peaked at 30.2%. Higher GDP and lower inequality were associated with groups with higher low-risk prevalence. Older age was associated with higher odds of nicotine/vaping, alcohol-dominant, and sexual-risk classes. Girls had lower odds of sexual-risk class membership but higher odds of alcohol-dominant patterns. Higher affluence was associated with alcohol-dominant class in some groups.
Conclusions
Risk behaviours cluster into distinct profiles that vary across national contexts. Prevention should target co-occurring behaviours and adapt to cross-national differences and social inequalities.
