Examining Secular Changes in Health Risk Behavior Profiles and Their Associations With Mental Distress During Adolescence

Objectives: Adolescent mental distress has increased in recent decades. It is unclear whether this is associated with changes in health-risk behaviors. Methods: = 30,122). Latent Profile Analyses identified health-risk behavior profiles in each wave using five indicators (physical inactivity, poor sleep, unhealthy diet, smoking, alcohol use). Associations with sociodemographic variables and mental distress (internalizing and somatic symptoms, life satisfaction) were tested using multinomial and linear regressions, including profile*sex interactions. Results: A consistent four-profile solution (low-risk; high alcohol use/slightly elevated substance use; moderate substance use; highest risk) fit best across waves. The low-risk profile was most prevalent and increased in later cohorts (2014-2018), while elevated-risk profiles declined. Older adolescents were more likely to belong to elevated-risk groups, which were associated with greater mental distress, especially in earlier cohorts. No significant sex interactions were found. Conclusion: Health-risk behavior profiles remained stable, but their associations with mental distress weakened over time. Prevention efforts should adapt to evolving adolescent contexts.