Identifying Cardiovascular Risk Profiles Clusters among Mediterranean Adolescents across Seven Countries

Abstract

Cardiovascular diseases (CVDs) are the number one cause of death globally and are partially due to the inability to control modifiable lifestyle risk factors. The aim of this study was to analyze the profiles of adolescents from seven Mediterranean countries (Greece, Israel, Italy, Macedonia, Malta, Portugal, Spain) according to their modifiable lifestyle risk factors for CVD (overweight/obesity, physical activity, smoking, alcohol consumption). The sample consisted of 26,110 adolescents (52.3% girls) aged 11, 13, and 15 years who participated in the Health Behavior in School-aged Children (HBSC) survey in 2018 across the seven countries. Sociodemographic characteristics (sex, age, country of residence, socioeconomic status) and CVD modifiable lifestyle risk factors (overweight/obesity, physical activity, smoking, alcohol consumption) were recorded. A two-step cluster analysis, one-way analysis of variance, and chi-square test were performed. Four different cluster groups were identified: two low-risk groups (64.46%), with risk among those with low physical activity levels; moderate-risk group (14.83%), with two risk factors (unhealthy weight and low physical activity level); and a high-risk group (20.7%), which presented risk in all modifiable lifestyle risk factors. Older adolescents reported a higher likelihood of being in the high-risk group. Given that the adolescence period constitutes an important time for interventions aimed at CVD prevention, identifying profiles of moderate- and high-risk adolescents is crucial.

Risk Behaviors, Family Support, and Emotional Health among Adolescents during the COVID-19 Pandemic in Israel

“…Risk behavior in adolescence is a socially unacceptable voluntary behavior with the potential for direct or indirect harm to a person, in which no precautions are taken, such as drinking alcohol and driving, drug use, tobacco smoking, frequent absences from school, delinquency, and more [ 9 ].…”

“…Specifically, the current study examines substance use of alcohol, cannabis, and cigarettes, which are the leading areas of public health concern for adolescents. Alcohol use in adolescence is considered a matter of public health concern due to its interrelation to additional risk behaviors, the tendency for alcohol use to persist into adulthood, and the impact it can have on the adolescent brain and health in general [ 9 , 10 ]. Alcohol use is the leading cause for cause-specific disability-adjusted life years (DALYs) for young people aged 10–24 years.…”

“…Studies demonstrated that cannabis use is a potential cause for the development of psychotic disorders such as schizophrenia and may lead to permanent cognitive impairment. Additionally, cannabis use is associated with involvement in physical hazards and chronic diseases [ 9 , 10 , 11 , 12 , 13 ].…”

After school: Volunteering in community emergency services and substance use among Israeli adolescents

“…Our findings suggest that the mental and physical impact of volunteering in community emergency services may overcome the strong protective effect against risky behaviors attributed to volunteering, while it may increase the prevalence of substance abuse among adolescents. Theories that explain health‐risk behaviors observed a clustering effect for risk behaviors, such that these actions did not remain isolated risk behaviors (Kann et al, 2018; Tesler et al, 2022). Smoking was found to be more frequently associated with other risk behaviors, such as problematic alcohol use, illicit drug use, or violent behavior (Tesler et al, 2020; Wolgast & Donat, 2019).…”

“…According to the 2017 Youth Risk Behavior Survey, 29.8% of sampled high school students across the United States reported alcohol use and 19.8% reported cannabis use (Kann et al, 2018) In addition, 14.0% of students had abused prescription pain medication at least once (Andrews et al, 2020). In comparison, according to the Health Behavior in School-aged Children (HBSC) survey that sampled high school students in Israel, about 15% reported cigarette smoking, 15% reported alcohol use, and another 10% reported cannabis use (Tesler et al, 2022).…”