Clustering of Risk Behaviors and Associated Psychosocial Factors among Youth in Tamil Nadu: A Cross-sectional Study

Background: Risk behaviors are prevalent among young people and can have serious consequences for their well-being. While these behaviors have been studied individually, there is little understanding of how they occur together and influence the mental and social well-being of youth. Aim: In this cross-sectional study, we analyzed several risk behaviors among youth in Tamil Nadu to identify potential clusters and examine the psychosocial differences between them. Methods: This cross-sectional study included a sample of 1861 college students across the state. Study data were collected using survey questions on sociodemographic information, alcohol use, tobacco use, drug use, self-harm behaviors and internet use, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, a subscale from the Educational Stress Scale for Adolescents and a checklist for significant life events. Results: Latent class analysis revealed two distinct clusters – “low risk” (90.4%) and “high risk” (9.6%) groups. The low-risk group engaged in no or at most two risk behaviors, while the latter engaged in more than two risk behaviors. Independent t -test and Chi-square test revealed significantly higher depression ( P < 0.01), anxiety ( P < 0.01), and a greater incidence of life events ( P < 0.01) in the high-risk group. Academic pressure and internet use showed no association with the clusters. Conclusion: The findings highlight the mental health challenges associated with engagement in multiple risk behaviors and strongly suggest the need for targeted interventions to address their impact on youth well-being.