BackgroundRecent studies show several health-related behaviors to cluster in adolescents. This has important implications for public health. Interrelated behaviors have been shown to be most effectively targeted by multimodal interventions addressing wider-ranging improvements in lifestyle instead of via separate interventions targeting individual behaviors. However, few previous studies have taken into account a broad, multi-disciplinary range of health-related behaviors and connected these behavioral patterns to health-related outcomes. This paper presents an analysis of the clustering of a broad range of health-related behaviors with relevant demographic factors and several health-related outcomes in adolescents.MethodsSelf-report questionnaire data were collected from a sample of 2,690 Dutch high school adolescents. Behavioral patterns were deducted via Principal Components Analysis. Subsequently a Two-Step Cluster Analysis was used to identify groups of adolescents with similar behavioral patterns and health-related outcomes.ResultsFour distinct behavioral patterns describe the analyzed individual behaviors: 1- risk-prone behavior, 2- bully behavior, 3- problematic screen time use, and 4- sedentary behavior. Subsequent cluster analysis identified four clusters of adolescents. Multi-problem behavior was associated with problematic physical and psychosocial health outcomes, as opposed to those exerting relatively few unhealthy behaviors. These associations were relatively independent of demographics such as ethnicity, gender and socio-economic status.ConclusionsThe results show that health-related behaviors tend to cluster, indicating that specific behavioral patterns underlie individual health behaviors. In addition, specific patterns of health-related behaviors were associated with specific health outcomes and demographic factors. In general, unhealthy behavior on account of multiple health-related behaviors was associated with both poor psychosocial and physical health. These findings have significant meaning for future public health programs, which should be more tailored with use of such knowledge on behavioral clustering via e.g. Transfer Learning.

Schools are increasingly involved in efforts to promote health and healthy behavior among their adolescent students, but are healthier students better learners? This synthesis of the empirical, longitudinal literature investigated the effects of the most predominant health-related behaviors—namely, alcohol and marijuana use, smoking, nutrition, physical activity, sexual intercourse, bullying, and screen time use (television, Internet, video games)—on the academic performance of adolescents. Thirty studies dating back to 1992 were retrieved from the medical, psychological, educational, and social science literature. Healthy nutrition and team sports participation were found to have a positive effect on academic performance, whereas the effects of alcohol use, smoking, early sexual intercourse, bullying, and certain screen time behaviors were overall negative. Generally, all relations of health-related behaviors and academic performance were dependent on contextual factors and were often mediated by psychosocial problems, social structures, and demographics. Findings were interpreted with use of sociological theories.

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Screen time was of significant importance to adolescent health. Behavioral interrelatedness caused significant confounding in the studied relations when behaviors were analyzed separately compared to a multi-behavioral approach, which speaks for more multi-behavioral analyses in future studies.