Clustering of health-related behaviours within children aged 11–16: a systematic review

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Abstract

Objective

We aimed to systematically review and synthesise evidence on the clustering of a broad range of health-related behaviours amongst 11–16 year olds.

Method

A literature search was conducted in September 2019. Studies were included if they used cluster analysis, latent class analysis, prevalence odds ratios, principal component analysis or factor analysis, and considered at least three health-related behaviours of interest among 11–16 year olds in high-income countries. Health-related behaviours of interest were substance use (alcohol, cigarettes and other drug use) and other behavioural risk indicators (diet, physical activity, gambling and sexual activity).

Results

The review identified 41 studies, which reported 198 clusters of health-related behaviours of interest. The behaviours of interest reported within clusters were used to define eight behavioural archetypes. Some included studies only explored substance use, while others considered substance use and/or other health-related behaviours. Consequently, three archetypes were comprised by clusters reporting substance use behaviours alone. The archetypes were: (1) Poly-Substance Users, (2) Single Substance Users, (3) Substance Abstainers, (4) Substance Users with No/Low Behavioural Risk Indicators, (5) Substance Abstainers with Behavioural Risk Indicators, (6) Complex Configurations, (7) Overall Unhealthy and (8) Overall Healthy.

Conclusion

Studies of youth health behavioural clustering typically find both a ‘healthy’ cluster and an ‘unhealthy’ cluster. Unhealthy clusters are often characterised by poly-substance use. Our approach to synthesising cluster analyses may offer a means of navigating the heterogeneity of method, measures and behaviours of interest in this literature.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-10140-6.

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Most cited references 63

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Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS)

Martin J. Downes, Marnie L. Brennan, Hywel Williams … (2016)

Objectives The aim of this study was to develop a critical appraisal (CA) tool that addressed study design and reporting quality as well as the risk of bias in cross-sectional studies (CSSs). In addition, the aim was to produce a help document to guide the non-expert user through the tool. Design An initial scoping review of the published literature and key epidemiological texts was undertaken prior to the formation of a Delphi panel to establish key components for a CA tool for CSSs. A consensus of 80% was required from the Delphi panel for any component to be included in the final tool. Results An initial list of 39 components was identified through examination of existing resources. An international Delphi panel of 18 medical and veterinary experts was established. After 3 rounds of the Delphi process, the Appraisal tool for Cross-Sectional Studies (AXIS tool) was developed by consensus and consisted of 20 components. A detailed explanatory document was also developed with the tool, giving expanded explanation of each question and providing simple interpretations and examples of the epidemiological concepts being examined in each question to aid non-expert users. Conclusions CA of the literature is a vital step in evidence synthesis and therefore evidence-based decision-making in a number of different disciplines. The AXIS tool is therefore unique and was developed in a way that it can be used across disciplines to aid the inclusion of CSSs in systematic reviews, guidelines and clinical decision-making.

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A systematic review: the influence of social media on depression, anxiety and psychological distress in adolescents

Betul Keles, Niall McCrae, Annmarie Grealish (2019)

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A systematic review on the clustering and co-occurrence of multiple risk behaviours

Nick Meader, Kristelle King, Thirimon Moe-Byrne … (2016)

Background Risk behaviours, such as smoking and physical inactivity account for up to two-thirds of all cardiovascular deaths, and are associated with substantial increased mortality in many conditions including cancer and diabetes. As risk behaviours are thought to co-occur in individuals we conducted a systematic review of studies addressing clustering or co-occurrence of risk behaviours and their predictors. As the main aim of the review was to inform public health policy in England we limited inclusion to studies conducted in the UK. Methods Key databases were searched from 1990 to 2016. We included UK based cross-sectional and longitudinal studies that investigated risk behaviours such as smoking, physical inactivity, unhealthy diet. High heterogeneity precluded meta-analyses. Results Thirty-seven studies were included in the review (32 cross-sectional and five longitudinal). Most studies investigated unhealthy diet, physical inactivity, alcohol misuse, and smoking. In general adult populations, there was relatively strong evidence of clustering between alcohol misuse and smoking; and unhealthy diet and smoking. For young adults, there was evidence of clustering between sexual risk behaviour and smoking, sexual risk behaviour and illicit drug use, and sexual risk behaviour and alcohol misuse. The strongest associations with co-occurrence and clustering of multiple risk behaviours were occupation (up to 4-fold increased odds in lower SES groups) and education (up to 5-fold increased odds in those with no qualifications). Conclusions Among general adult populations, alcohol misuse and smoking was the most commonly identified risk behaviour cluster. Among young adults, there was consistent evidence of clustering found between sexual risk behaviour and substance misuse. Socio-economic status was the strongest predictor of engaging in multiple risk behaviours. This suggests the potential for interventions targeting multiple risk behaviours either sequentially or concurrently particularly where there is evidence of clustering. In addition, there is potential for intervening at the social or environmental level due to the strong association with socio-economic status. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3373-6) contains supplementary material, which is available to authorized users.

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Author and article information

Contributors

Victoria Whitaker:

ORCID: http://orcid.org/0000-0001-7883-3852

v.whitaker@sheffield.ac.uk

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 14 January 2021

Publication date PMC-release: 14 January 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 137

Affiliations

[1 ]GRID grid.11835.3e, ISNI 0000 0004 1936 9262, Health Sciences School, , University of Sheffield, ; Sheffield, UK

[2 ]GRID grid.11835.3e, ISNI 0000 0004 1936 9262, School of Health and Related Research, , University of Sheffield, ; Sheffield, UK

Author information

Victoria Whitaker http://orcid.org/0000-0001-7883-3852

Article

Publisher ID: 10140

DOI: 10.1186/s12889-020-10140-6

PMC ID: 7807795

PubMed ID: 33446174

SO-VID: ac416b40-d058-46a2-9a8f-29e5fdf56a20

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 20 April 2020

Date accepted : 28 December 2020

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100004440, Wellcome Trust;

Award ID: 208090/Z/17/Z

Award Recipient : John Holmes

Custom metadata

ScienceOpen disciplines: Public health

Keywords: cluster analysis,health behaviours,youth,multiple risk factors,systematic review,children

Data availability:

ScienceOpen disciplines: Public health

Keywords: cluster analysis, health behaviours, youth, multiple risk factors, systematic review, children

Clustering of health-related behaviours within children aged 11–16: a systematic review

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Abstract

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Method

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Supplementary Information

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Chinese Journal of School Health

Most cited references 63

Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS)

A systematic review: the influence of social media on depression, anxiety and psychological distress in adolescents

A systematic review on the clustering and co-occurrence of multiple risk behaviours

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