Latent class analysis of sexual behavior patterns and multidimensional health characteristics among Korean adolescents: a cross-sectional study

PURPOSE: Adolescents with same-sex or both-sex sexual experience face disproportionate health risks, yet research has predominantly examined single health problems rather than their multidimensional patterns. This study employed latent class analysis (LCA) to identify distinct health typological classes among Korean adolescents and characterize the distribution of sexual behavior patterns across these classes. METHODS: We analyzed 278,066 middle- and high-school students in the 2013-2016 Korea Youth Risk Behavior Survey. The LCA used 17 indicators encompassing sexual behavior patterns, health behaviors, health perceptions, and mental health. Complex-sample weighted analyses examined associations between latent classes and sociodemographic characteristics, sexual behaviors, and diseases. RESULTS: Four distinct classes were identified: mental health high-risk group (10.1%), substance use high-risk group (6.5%), average group (36.3%), and healthy group (47.1%). Adolescents with same-sex or both-sex sexual experience were disproportionately concentrated in the two high-risk classes, comprising 3.3% of the mental health high-risk group and 4.1% of the substance use high-risk group, compared with only 0.3% and 0.5% of the average group and the healthy group. The mental health high-risk group exhibited extremely elevated prevalence rates of suicidal ideation (96.2%), depressive symptoms (88.5%), and suicide attempts (27.5%), while the substance use high-risk group showed high rates of smoking (82.4%) and alcohol use (84.6%) but better mental health. CONCLUSION: Adolescents with same-sex or both-sex sexual experience demonstrate health inequality through disproportionate classification in the mental health high-risk group and the substance use high-risk group. The findings underscore the need for integrated interventions combining mental health support and substance use prevention.