Factors associated with clustering of multiple health-risk behaviours in young people in England

Background: Most chronic diseases are strongly associated with four modifiable behaviours: smoking, alcohol consumption, low fruit and vegetable consumption and physical inactivity. When established early in life, these lifestyle factors could persist in adulthood and predict the incidence of chronic diseases. Little is known about how these behaviours cluster together, and what factors are associated with their prevalence and clustering in individuals. The objective of this study was to ascertain the association between sociodemographic and personal factors and clustering of multiple health-risk behaviours in young people in the city of Brighton and Hove (population, 274,000) in Southeast England. Methods: Data from the Brighton and Hove Safe and Well at School Surveys (2011-2014) were analysed to examine the clustering of these behaviours in Year 10 and 11 pupils (n=10,099; aged 14-16 year). The results were weighted and studied in the context of sociodemographic/personal characteristics: gender, ethnicity, sexual orientation, deprivation, school year, feeling safe at school, enjoying school, been bullied at school, health problems, family problems, feeling happy, feeling anxious and feeling lonely. Results: The majority (97%) of pupils were engaged in either one or more unhealthy behaviours: about 58% were engaged in 1-2 and 39% were engaged in 3-4 unhealthy behaviours, respectively. Multiple regression analysis showed that a number of factors were significantly associated with the clustering of 3-4 health-risk behaviours in young people. These included: being in Year 11 (OR=2.0, 95% CI, 1.8-2.2), family problems (1.8, 1.6-2.0), being female (1.7, 1.5-1.9), not enjoying school (1.6, 1.4-1.8), and rarely/never feeling happy (1.3, 1.0-1.6). Conclusions: These findings highlight the need for modifications in community-based and in-school health and wellbeing programmes to decrease the prevalence and clustering of multiple health-risk behaviours in young people. Main messages: There is a need for effective programmes for young people to increase their awareness about health impacts of smoking and alcohol consumption, and beneficial effects of healthy diet and exercise. The study also highlights areas which require particular considerations while designing these programmes for young people.