Factors associated with risk behaviors in adolescence: a systematic review

Social network analysis to study health behaviours in adolescents: A systematic review of methods

PURPOSE

Our objectives were (i) to systematically review how SNA is used in studies investigating adolescent health behaviours (i.e., the purpose of using SNA, methods used for network data collection and analysis), and (ii) to develop methodological guidelines to help researchers use SNA in studies on adolescent health behaviours.

METHODS

Five databases were searched using keywords related to "social network analysis" and "adolescents". We extracted data from included articles pertaining to the choice of methods for network data collection and analysis. We used these data to develop a 5-step decision tree to help researchers make methodological decisions most appropriate to their research objectives.

RESULTS

A total of 201 articles were included. Most investigated tobacco (50%) or alcohol use (48%). SNA was used most often to examine processes related to peer selection or influence (37%) and/or to examine the effect of sociometric position on health behaviours (34%). 181 studies (90%) used a sociocentric approach for SNA, 16 studies (8%) used an egocentric approach, and 4 studies (2%) used both. We identified five decision-making steps in SNA including the choice of: (i) network boundary, (ii) SNA approach, (iii) methods for name generators, (iv) methods for name interpreters, and (iv) SNA indicators.

CONCLUSION

This study provides insights and guidance in a 5-step decision tree on practical and methodological considerations in using SNA to explore adolescent health behaviours.

Internalized homophobia and sexual risk behavior in men who have sex with men: The mediational role of sexual self-concept

Men who have sex with men (MSM) are one of the populations most likely to be infected with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) worldwide. Sexual risk behaviors (SRB) are the main route of HIV transmission. Among the factors associated with SRB, internalized homophobia (rejection of one's sexuality) is a risk factor unique for MSM. However, how this factor influences SRB is not clear. Therefore, the present study attempts to clarify the mechanism of action of the relationship between internalized homophobia on SRB based on the mediating effects of sexual self-concept. A study was conducted with 124 MSM living in Chile over 18 years of age (M = 24.4 and SD = 4.19). Through path analysis, it was observed that internalized homophobia has slight inverse effects on SRBs (multiple sexual partners and sexual activity under the influence of alcohol or drugs) when the sexual self-efficacy dimension acts as a mediating variable. These findings suggest that developing sexually transmitted infections (STIs) and HIV/AIDS prevention campaigns focused on MSM must highlight the development of a healthy sexual self-concept and address self-stigma.

Who Is Able to Resist What Is Forbidden?—The Relationship between Health Literacy and Risk Behaviours in Secondary School Students in the Broader Social and Educational Context

In the last Health Behaviour in School-Aged Children (HBSC) survey conducted in Poland in 2018, a group of 17-year-old adolescents (n = 1663; mean age 17.63 ± 0.36 years) was included outside the international protocol. This allowed an assessment to be made of their level of health literacy (HL) using the 10-point HBSC research tool. The aim of the study was to investigate the relationship between HL and risk behaviours (RB). A standardised index of RB in the last 30 days was considered as an outcome measure. This index was significantly higher in the group with low HL (0.318 ± 1.269) in comparison with the group with high HL (−0.083 ± 0.962). In a multivariate linear regression model, the strongest predictors of RB were gender, academic performance and level of regional deprivation, but the association with HL remained significant. This significant association persisted in general schools and in girls but disappeared in vocational schools and in boys. It was also shown that in rural areas, good academic performance has a less significant impact on RB if the HL level is low. The analyses led to the conclusion that when examining the relationship between HL and RB in older adolescents, it is advisable to take into account gender, the educational track and neighbourhood characteristics.

Is Adolescent Risk Behavior Associated With Cross-Household Family Complexity? An Analysis of Post-separation Families in 42 Countries

We examine whether complex cross-household structures of post-separation families are associated with higher risk-taking behavior in adolescence (substance use, bullying, early sexual onset) and whether the proportion, and thus statistical normality, of complex family types in a certain country is a potential moderator of this association. Drawing on representative data from 42 countries and regions from the Health Behavior in School-aged Children (HBSC) study in 2001, 2006, and 2010 (N = 506,977), we provide detailed analyses on adolescent risk behavior even for very rare family types, thereby accounting for the complex cross-household structure present in many post-separation families. We combine logistic and count regression models to analyze risk incidence and intensity. Controlling for relevant child and family characteristics, our results reveal a gradient along which adolescent risk-taking increases with family complexity: The incidence and intensity of risk-taking among adolescents is lowest in two-biological-parent and highest in two-household families with stepparents in both households. The association decreases with a higher proportion of the respective family type in a country. However, the differences between family types, other than the two-biological parent family, are not as pronounced as expected.

Risk factors for self-harm and suicidal ideation and behaviour in adolescents and young adults: a protocol for an umbrella review of systematic reviews

Background:There are many primary studies on the risk and protective factors for self-harm and suicidal ideation and/or behaviour in the adolescent and young adult (AYA) age group.  Moreover, there have been many systematic reviews on these primary studies. Some of these focus on a specific population, a geographic area, a specific risk factor or a socioeconomic group, whereas others are more general in their approach.  An umbrella review of these systematic reviews is an appropriate design to synthesise the available research regarding the main risks and protective factors for self-harm and suicidal ideation and/or behaviour in AYAs and to establish the relative strength of the associations of these risk and protective factors.    Methods and analysis: The PRISMA-P checklist was used for this protocol. The databases to be used for this umbrella review will be Ovid Medline, Embase, APA PsycInfo, the Cochrane Database of Systematic Reviews, CINAHL, and Scopus.  Systematic reviews included will date as far back as the year 2010 and up to the present so as to ensure that the evidence is contemporary and up-to-date.  Two authors, including the first author, will independently screen the results for inclusion.  The AMSTAR 2 checklist will be used for the quality assessment process and the overall strength of the body of evidence will be assessed using the GRADE tool.     Prospero registration number: CRD42021282277

The Explanation of Adolescent Delinquent Behaviors Based on Jessor's Problem Behavior Theory (PBT) in Iran: The Role of Individual Vulnerability, Opportunity Risk Availability, and Perceived Support

This study tested the generality of Problem Behavior Theory (PBT) in explaining adolescents' problem behavior in Iran. Data were collected from 392 adolescents (Mage = 15.97, SD = 1.12, 55.4% girls) who completed the Adolescent Health and Development Questionnaire (AHDQ) to assess the individual vulnerability, opportunity risk availability, perceived support, and delinquent behaviors. Results indicated that individual vulnerability and opportunity risk availability had a significant relationship with delinquent behaviors and a significant interaction with perceived support in their influence on delinquent behaviors. Further, perceived support was negatively associated with delinquent behaviors. Our results were consistent with PBT's explanatory model for adolescents' problem behavior in Western countries and are informative about problem behavior involvement among Iranian adolescents and the design of interventions.

Conscientiousness moderates the relationship between neuroticism and health-risk behaviors among adolescents

Health-Risk-Behaviors (HRBs) are considered significant antecedent conditions of adolescents' poor health and mortality. Prevention of any adverse health outcome requires an in-depth understanding of the risk and protective factors associated with its development and maintenance. Among other potential causal pathways, the "neuroticism- HRBs-adverse health" link has been supported in previous studies. Trait neuroticism has been associated with poor health and HRBs, but several moderators were also observed, which might transform neuroticism into a desirable phenomenon, that is, healthy neuroticism, that leads to better health. Conscientiousness is one such potential moderator; however, the moderating effect of conscientiousness in the neuroticism-HRBs link has not been explored extensively among adolescents, especially in India; therefore, no conclusive evidence is available. Thus, the present study was planned to explore the moderating effect of conscientiousness in the relationship between neuroticism and HRBs among adolescents. The study was conducted in India and its cross-sectional sample, procured through a multi-stage stratified random sampling, consists of 648 (364 males) adolescents (M_age  = 16.08). Participants provided relevant information on standardized questionnaires. Moderated regression analysis was applied to test the stated hypotheses. Individuals high on neuroticism and low on conscientiousness reported more indulgence in health-risk behaviors than individuals high on both neuroticism and conscientiousness. It indicates that a higher level of conscientiousness may reduce the negative impact that neuroticism has on HRBs. The findings imply that the assessment of conscientiousness and strategies to increase the same should be part of interventional programs to achieve adolescents' wellbeing.

Emotion regulation difficulties, perceived parenting and personality as predictors of health-risk behaviours among adolescents

Health-Risk Behaviours (HRBs) are significant antecedent conditions of adverse health outcomes among adolescents, and their prevention requires an in-depth understanding of associated factors. Like any other behaviour, HRBs may be an outcome of a complex interplay between personal and situational factors that determines our responses. Among other factors, emotional tendencies, specific behavioural patterns, and psychosocial environment may be the significant factors working at different hierarchical positions within a system and guiding human behaviours, including HRBs. Previous studies have explored the role of these specific factors in developing and maintaining HRBs, but mainly among the adult population, and no conclusive results could be observed regarding their contribution to HRBs in adolescents. The present study explored the predictability of adolescents' engagement in HRBs with regard to three representations of the mentioned factors, i.e., emotion regulation difficulties, perceived parenting practices and personality traits. A total of 723 (Males = 440) adolescents (Mage = 16.05, SD = 1.1) provided relevant information on the standardized questionnaires. Structural equation modelling was applied to test the stated hypotheses. Analysis revealed that the adolescents who reported more difficulty regulating one's emotions, perceived parenting practice as maladaptive, scored high on neuroticism and low on conscientiousness, showed more engagement in HRBs than their counterparts. Further, the findings indicated that emotion regulation difficulties and perceived parenting practices are stronger predictors of HRBs than personality traits. Interventional programs targeting HRBs among adolescents should address specific facets of emotional dysregulation and sensitise parents about their role in moderating adolescents' HRBs.

Early-life maternal attachment and risky health behaviours in adolescence: findings from the United Kingdom Millennium Cohort Study

Background

Early uptake of multiple risky behaviours during adolescence, such as substance use, antisocial and sexual behaviours, can lead to poor health outcomes without timely interventions. This study investigated how early-life maternal attachment, or emotional bonds between mothers and infants, influenced later risky behaviours in adolescence alongside other potential explanatory pathways using the United Kingdom Millennium Cohort Study.

Methods

Total maternal attachment scores measured at 9 months using the Condon (1998) Maternal Postnatal Attachment Scale compared higher and lower attachment, where mothers in the lowest 10th percentile represented lower attachment. Multiple risky behaviours, defined as two or more risky behaviours (including smoking cigarettes, vaping, alcohol consumption, illegal drug use, antisocial behaviour, criminal engagement, unsafe sex, and gambling), were scored from 0 to 8 at age 17. Five multivariate logistic regression models examined associations between maternal attachment and multiple risky behaviours among Millennium Cohort Study members (n = 7796). Mediation analysis sequentially adjusted for blocks of explanatory mechanisms, including low attachment mechanisms (multiple births, infant prematurity, sex, breastfeeding, unplanned pregnancy and maternal age at birth), maternal depression, and social inequalities (single-parent status, socioeconomic circumstance by maternal education and household income) at 9 months and poor adolescent mental health at 14 years.

Results

Children of mothers with lower maternal attachment at 9 months had 23% increased odds of multiple risky behaviours at 17 years (OR: 1.23, 95% CI: 1.00–1.50) in the unadjusted baseline model. All five explanatory blocks attenuated baseline odds. Low attachment mechanisms attenuated 13%, social inequalities 17%, and poor mental health 17%. Maternal depression attenuated the highest proportion (26%) after fully adjusting for all factors (30%).

Conclusions

Lower maternal attachment in early life predicted increased adolescent multiple risky behaviours. Almost a third of the excess risk was attributable to child, maternal and socioeconomic factors, with over a quarter explained by maternal depression. Recognising the influence of early-life risk factors on adolescent health could innovate current policies and interventions addressing multiple risky behaviour uptake affecting health inequalities across the life course.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12141-5.

Mental health and risk behaviors among secondary school students: A study on ethnic minorities

BACKGROUND

Mental health disorders are highly correlated with risk behaviors. The objective of the present study is to examine the relationship between risk behaviors and mental health among school-going students with a focus on ethnic minorities.

METHODS

The National Health and Morbidity Survey (NHMS) 2017 (n = 8230) was used for analyses. It was a nationwide survey conducted in Malaysia. The dependent variables were measured by three risk behaviors (cigarette smoking, alcohol drinking and use of illicit drugs). Probit regressions were utilized to examine the effect of mental health on the probability of smoking, drinking and using illicit drugs. Demographic and lifestyle factors were used as the control variables. Truancy was identified as a mediating variable.

RESULTS

Anxiety, depression and suicidal ideation affected cigarette smoking, alcohol drinking and use of illicit drugs through mediation of truancy. After controlling for demographic and lifestyle factors, students with anxiety, depression and suicidal ideation were more likely to smoke, drink and use illicit drugs compared with their peers without any mental health disorders. Furthermore, the likelihood of consuming cigarettes, alcohol and illicit drugs was found to be higher among students who played truant than those who did not.

CONCLUSION

Mental health plays an important role in determining participation in risk behaviors among ethnic minority students in Malaysia. Public health administrators and schools have to be aware that students who suffer from mental health disorders are likely to indulge in risk behaviors.

The Relationship between Risk Perception and Risk Definition and Risk-Addressing Behaviour during the Early COVID-19 Stages

The purpose of this article is to show the effect of Risk Perception RP and Risk Definition RD on the Risk-Addressing Behaviour RB. To carry out this study secondary data was used from a semi-structured survey administered between February and June 2020, a period during the early stages of the COVID-19 pandemic. The study identified six dimensions of risk perception and thus tested six structural models. Risk perception (ξ RP) is defined as an external latent variable in the study. It is also assumed that the risk perception variable may affect the risk definition variable (η RD). The application software SmartPLS was used to analyse data through exploratory factor analysis and partial least squares structural equation modelling on our research model. To achieve Convergent validity of the structural equation model of partial least squares, three criteria were met. In the study, Discriminant Validity was examined using the Fornell-Larcker criterion and Heterotrain-Monotrait Ratio (HTMT) coefficients. Results reveal that there is no direct relationship between the RB and “religion and beliefs”, the “fear level, the experience”, the “peer influences level” and the “openness”. However, we found a positive relationship between the agreement on “knowledge” and on RB and statistically significant relationships between the agreement on the RD and the agreement on the “religion and beliefs”, the “fear level”, the “experience”, the “knowledge”, the “peer influences level” and the RB. Moreover, there is an indirect relationship when controlling for the agreement on the RD between the agreement on the RB and the agreement on the “fear level”, the “experience”, the “knowledge” and the “peer influences level”. However, there is no relationship between the agreement on the “openness” and the agreement on the RB and a statistically significant but moderate relationship between the agreement on the RD and the agreement on the RB. Although, there seems to be abundant research on RP, so far we have found only a few studies on the influencing factors of RP, as effected by RB and RD, especially in distressed times such as during this current pandemic period of COVID-19. This study adds to body of literature and sheds new light on the interaction between RP, RB and RD in a time of distress. It provides important and original information that may be useful for government agencies, businesses, individuals, and the media when setting policies, governance structures, regulations, procedures and determining how to communicate.

The predictor role of Internet addiction in high- risk behaviors and general health status among Alborz students: A structural equation model

Background

Internet addiction has become more prevalent in Adolescents. Some adolescents who tend to use Internet excessively have a poorer health status, and engage in more risky behaviors than others. Therefore, the aim of this study was to investigate the predictor role of Internet addiction in high- risk behaviors and the general health status among adolescences.

Methods

This was a descriptive-analytical study of structural equation modeling, conducted on 300 students of Alborz University of Medical Sciences. The multi-stage sampling method was used to identify the number of students aged 19–21 years studying in each faculty in the first stage and convenience sampling was used in the second stage. Data were collected using Iranian Adolescents Risk-taking Scale (IARS), the General Health Questionnaire (GHQ-28) and the Young's Internet Addiction Test (YIAT). The data were analyzed using LISREL version 8.8.

Results

The results of the measurement model using LISREL software showed a goodness of fit for the conceptual model. Internet addiction had a significant direct positive effect on the adolescents' high-risk behaviors (β = 0.17). Also, Internet addiction had a significant positive effect on the adolescents' general health status (β = 0.33) and general health problems increased by 0.33 per unit of Internet use. The result of structural model revealed no significant effects of general health on high-risk behaviors. Based on the value of the variance determined, Internet addiction could predict 11% of general health. Also, general health and Internet addiction together could predict 2.7% of high- risk behaviors.

Conclusion

Given the effect of Internet addiction on the general health and high-risk behavior, it is recommended that adolescents will be screened about internet addiction and the necessary training is given to the adolescents on the appropriate use of Internet. All necessary information should be given to the parents regarding Internet risks and dangers.