Clusters of lifestyle behaviours and their associations with mental health and other health-related issues among adolescents: Insights from a multi-ethic middle-income country

BACKGROUND: Clustering of modifiable lifestyle risk factors such as smoking, alcohol drinking, physical inactivity, sedentarism, and inadequate fruit/vegetable intake has been reported in previous studies, however, such studies are scarce among Malaysian adolescents. Therefore, the present study aims to determine the clustering patterns of these major lifestyle risk behaviours and their associations with socio-demographics and a wide range of health-related issues. METHODS: This is a cross-sectional study conducted among 3578 school-going adolescents aged 16-17 years from 40 secondary schools in Malaysia. FINDINGS: Two distinct clusters of lifestyle behaviours, "smoking and drinking" (comprising smoking and drinking) and "inactivity and unhealthy diet" (comprising physical inactivity, sedentary, inadequate intake of fruit/vegetable), were deduced via factor analysis. Boys, or those with poor academic performance were associated with the "smoking and drinking" cluster; whilst girls, non-Malay adolescents, those with poor academic performance, with divorced parents/guardians, or with little perceived parental connectedness were associated with the "inactivity and unhealthy diet" cluster. Adolescents in the "smoking and drinking" cluster were significantly associated with sexual behaviours (aOR 7.64, 95 %CI: 4.30-13.58), violence (aOR 5.49, 95 %CI: 2.40-12.57), and mental health problems (aOR 2.80, 95 %CI: 1.21-6.47). But both clusters were negatively associated with self-esteem (B = -1.97, 95 %CI: -2.63 to -1.31; B = -1.09, 95 %CI: -1.50 to -0.68). CONCLUSION: The present study revealed that lifestyle behaviours among school-going adolescents clustered in distinct patterns, each with specific associated socio-demographics and health-related issues. These findings could provide important insights to policymakers in planning and formulating targeted interventions among Malaysian adolescents.