Clustering Lifestyle Risk Behaviors among Vietnamese Adolescents and Roles of School: A Bayesian Multilevel Analysis of Global School-Based Student Health Survey 2019

Abstract

Background: Adolescence is a vulnerable period for many lifestyle risk behaviors. In this study, we investigated the clustering of risk behaviors and role of the school health promotion programs among adolescents in Vietnam. Methods: We analyzed data of 7,541 adolescents aged 13-17y from the 2019 nationally representative Global School-based Student Health Survey, conducted in 20 provinces and cities in Vietnam. We applied the latent class analysis to identify groups of clustering and used Bayesian 2-level logistic regressions to evaluate the effects of school health promotion programs on these clusters. We reassessed the school effect size by incorporating different informative priors to the Bayesian models. Findings: The most frequent lifestyle risk behavior among Vietnamese adolescents was unhealthy diet (~67%), followed by sedentary behavior (37% in boys and 48% in girls) and low fruit/vegetable intake (~31%). More than half of students had a cluster of at least two risk factors and a quarter with three risk factors. Latent class analysis detected 18% boys and 15% girls being at high-risk of lifestyle behaviors. Consistent through different priors, high quality of health promotion programs associated with lower the odds of lifestyle risk behaviors (highest quality schools vs. lowest quality schools; boys: Odds ratio (OR) = 0.69, 95% Highest Density Interval (HDI): 0.49 - 0.99; girls: OR = 0.62, 95% HDI: 0.42 - 0.92). Interpretation: Our findings demonstrated the clustering of specific lifestyle risk behaviors among Vietnamese adolescents, suggesting a special need for required courses in schools and join interventions that target sex-specific multiple risk behaviors.