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      Clustering of substance use and sexual risk behaviour in adolescence: analysis of two cohort studies

      , 1 , 2 , 1 , 3

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          The authors aimed to examine whether changes in health risk behaviour rates alter the relationships between behaviours during adolescence, by comparing clustering of risk behaviours at different time points.


          Comparison of two cohort studies, the Twenty-07 Study (‘earlier cohort’, surveyed in 1987 and 1990) and the 11-16/16+ Study (‘later cohort’, surveyed 1999 and 2003).


          Central Clydeside Conurbation around Glasgow City.


          Young people who participated in the Twenty-07 and 11-16/16+ studies at ages 15 and 18–19.

          Primary and secondary outcomes measures

          The authors analysed data on risk behaviours in both early adolescence (started smoking prior to age 14, monthly drinking and ever used illicit drugs at age 15 and sexual intercourse prior to age 16) and late adolescence (age 18–19, current smoking, excessive drinking, ever used illicit drugs and multiple sexual partners) by gender and social class.


          Drinking, illicit drug use and risky sexual behaviour (but not smoking) increased between the earlier and later cohort, especially among girls. The authors found strong associations between substance use and sexual risk behaviour during early and late adolescence, with few differences between cohorts, or by gender or social class. Adjusted ORs for associations between each substance and sexual risk behaviour were around 2.00. The only significant between-cohort difference was a stronger association between female early adolescent smoking and early sexual initiation in the later cohort. Also, relationships between illicit drug use and both early sexual initiation and multiple sexual partners in late adolescence were significantly stronger among girls than boys in the later cohort.


          Despite changes in rates, relationships between adolescent risk behaviours remain strong, irrespective of gender and social class. This indicates a need for improved risk behaviour prevention in young people, perhaps through a holistic approach, that addresses the broad shared determinants of various risk behaviours.

          Article summary

          Article focus
          • Previous studies have reported clustering of risk behaviours during adolescence.

          • Prior studies have not examined whether changes in risk behaviour rates affects relationships between these risk behaviours.

          • We examined clustering in early and later adolescent risk behaviours to determine if clustering differed at two different time points, by gender and by socioeconomic status, the latter of which has also tended not to be addressed in previous studies.

          Key messages
          • Despite changes in health risk behaviour rates, relationships between adolescent risk behaviours remain strong.

          • Relationships generally did not vary by gender or social class.

          • There is a need for improved risk behaviour prevention in young people, perhaps through a holistic approach that addresses the broad shared determinants of various risk behaviours.

          Strengths and limitations of this study
          • We compared cohorts of young people from the same geographic area and life stage, surveyed using (near) identical questions, 13 years apart. To our knowledge, this is the first study to examine time trends in associations between substance use and sexual behaviour.

          • We examined these associations in both early and late adolescence and by gender and social class, the latter of which has not been previously investigated.

          • Although we accounted for loss to follow-up in the 1999/2003 study via weighted analyses, we may not have fully compensated for differential loss to follow-up of adolescents with more ‘risky’ patterns of behaviour.

          • Questions on alcohol intake included a more detailed drinking grid in the 1999/2003 study, which possibly encouraging increased reporting in this later cohort, while use of interviewer-administered questionnaires may have led to under-reporting of behaviours.

          Related collections

          Most cited references 35

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          Structure of problem behavior in adolescence and young adulthood.

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            Preventing adolescent health-risk behaviors by strengthening protection during childhood.

            To examine the long-term effects of an intervention combining teacher training, parent education, and social competence training for children during the elementary grades on adolescent health-risk behaviors at age 18 years. Nonrandomized controlled trial with follow-up 6 years after intervention. Public elementary schools serving high-crime areas in Seattle, Wash. Of the fifth-grade students enrolled in participating schools, 643 (76%) were given written parental consent for the longitudinal study and 598 (93%) were followed up and interviewed at age 18 years. A full intervention provided in grades 1 through 6 of 5 days of in-service training for teachers each intervention year, developmentally appropriate parenting classes offered to parents when children were in grades 1 through 3 and 5 through 6, and developmentally adjusted social competence training for children in grades 1 and 6. A late intervention, provided in grades 5 and 6 only, paralleled the full intervention at these grades. Self-reported violent and nonviolent crime, substance use, sexual activity, pregnancy, bonding to school, school achievement, grade repetition and school dropout, suspension and/or expulsion, and school misbehavior; delinquency charges from court records; grade point average; California Achievement Test scores: and disciplinary action reports from school records. Fewer students receiving full intervention than control students reported violent delinquent acts (48.3% vs 59.7%; P=.04), heavy drinking (15.4% vs 25.6%; P=.04), sexual intercourse (72.1% vs 83.0%; P=.02), having multiple sex partners (49.7% vs 61.5%; P=.04), and pregnancy or causing pregnancy (17.1% vs 26.4%; P=.06) by age 18 years. The full intervention student group reported more commitment (P=.03) and attachment (P=.006) to school, better academic achievement (P=.01), and less school misbehavior (P=.02) than control students. Late intervention in grades 5 and 6 only did not significantly affect health-risk behaviors in adolescence. A package of interventions with teachers, parents, and children provided throughout the elementary grades can have enduring effects in reducing violent behavior, heavy drinking, and sexual intercourse by age 18 years among multiethnic urban children. Results are consistent with the theoretical model guiding the intervention and support efforts to reduce health-risk behaviors through universal interventions in selected communities or schools serving high-crime neighborhoods.
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              Assessment of factors affecting the validity of self-reported health-risk behavior among adolescents: evidence from the scientific literature.

              We reviewed the existing empirical literature to assess cognitive and situational factors that may affect the validity of adolescents' self-reports of alcohol and other drug use, tobacco use, behaviors related to unintentional injuries and violence, dietary behaviors, physical activity, and sexual behavior. Specifically, we searched for peer-reviewed journal articles published in 1980 or later that examined the factors affecting self-report of the six categories of behavior listed above. We also searched for studies describing objective measures for each behavior. Self-reports of each of six types of health-risk behaviors are affected by both cognitive and situational factors. These factors, however, do not threaten the validity of self-reports of each type of behavior equally. The importance of assessing health-risk behaviors as part of research activities involving adolescents necessitates the use of self-report measures. Researchers should familiarize themselves with the threats to validity inherent in this type of assessment and design research that minimizes these threats as much as possible.

                Author and article information

                BMJ Open
                BMJ Open
                BMJ Open
                BMJ Group (BMA House, Tavistock Square, London, WC1H 9JR )
                8 February 2012
                8 February 2012
                : 2
                : 1
                [1 ]Scottish Collaboration for Public Health Research and Policy, MRC Human Genetics Unit Building, Western General Hospital, Edinburgh, UK
                [2 ]MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK
                [3 ]Centre for Public Health & Population Health Research, School of Nursing, Midwifery and Health, University of Stirling, Stirling, Scotland, UK
                Author notes
                Correspondence to Dr Caroline Jackson; caroline.jackson@
                © 2012, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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