Clustering of health-related behaviors among early and mid-adolescents in Tuscany: results from a representative cross-sectional study

Abstract

BackgroundA huge amount of literature suggests that adolescents’ health-related behaviors tend to occur in clusters, and the understanding of such behavioral clustering may have direct implications for the effective tailoring of health-promotion interventions. Despite the usefulness of analyzing clustering, Italian data on this topic are scant. This study aimed to evaluate the clustering patterns of health-related behaviors.MethodsThe present study is based on data from the Health Behaviors in School-aged Children (HBSC) study conducted in Tuscany in 2010, which involved 3291 11-, 13- and 15-year olds. To aggregate students’ data on 22 health-related behaviors, factor analysis and subsequent cluster analysis were performed.ResultsFactor analysis revealed eight factors, which were dubbed in accordance with their main traits: ‘Alcohol drinking’, ‘Smoking’, ‘Physical activity’, ‘Screen time’, ‘Signs & symptoms’, ‘Healthy eating’, ‘Violence’ and ‘Sweet tooth’. These factors explained 67% of variance and underwent cluster analysis. A six-cluster κ-means solution was established with a 93.8% level of classification validity. The between-cluster differences in both mean age and gender distribution were highly statistically significant.ConclusionsHealth-compromising behaviors are common among Tuscan teens and occur in distinct clusters. These results may be used by schools, health-promotion authorities and other stakeholders to design and implement tailored preventive interventions in Tuscany.

Clustering of health-related behaviours and its relationship with individual and contextual factors in Portuguese adolescents: results from a cross-sectional study

“…Most studies show smoking clusters with alcohol abuse in complex ways [10,21]. One study in Italy using HBSC data found 6 clusters ("smoking drinker", "nondrinking smoker", "quasi-healthy", "symptomatic", "violent" and "screen passion") [22]. Similarly, in our study alcohol and tobacco use both clustered in the same group ("Substance users"), comprising older adolescents.…”

Clustering of diet, physical activity and sedentary behavior among Brazilian adolescents in the national school - based health survey (PeNSE 2015)

“…However, different from our results, they also identified the least time being sedentary. The literature remains inconsistent with some observational studies showing that clusters with high levels of PA are characterized by low levels of SB or screen time [ 26 – 28 ], whereas others reported a coexistence of high levels of both in the same cluster [ 5 , 26 ]. Dumuid et al [ 15 ] observed, among samples of children from twelve different countries, that the cluster of high screen time and high PA appears only for Brazilians, corroborating our results.…”

Clustering of Six Key Risk Behaviors for Chronic Disease among Adolescent Females

“…This clustering is reflected in the recent adoption of 24-h movement guidelines in Canada [ 20 ] and Australia [ 14 ], which recognize the importance of addressing physical activity, sedentary behavior/screen time, and sleep in conjunction. Alcohol use and smoking are also known to commonly co-occur [ 21 ], and the clustering of physical activity, diet, and sedentary behavior in adolescence is well established [ 22 ]. Evidence suggests this clustering differs by sex, with adolescent females comprising unhealthy clusters characterized by low physical activity [ 22 ], and females more likely than males to engage in multiple risk behaviors [ 23 ].…”