Socio-ecological risk factors associated with different health-risk behaviors among Chinese adolescents: a cross-sectional study

Objective To explore the association between the level of socio-ecological risk factors and adolescent health risk behaviors, and to provide theoretical basis for reducing the occurrence of adolescent risk behaviors and improving adolescent behavioral problems. Methods This cross-sectional study was conducted in Zhengzhou City and 3377 participants were enrolled. Perceived socio-ecological risk was measured using a validated 50-item questionnaire. Grounded in ecological systems theory, investigating the risk factors associated with adolescent health risk behaviors across individual, family, school, community, policy, cultural and chronosystem level. Health risk behavior outcomes including diet, physical activity, sleep duration and screen time on weekdays and weekends, drinking and smoking behaviors and then divided into healthy and unhealthy groups. Independent t-test, ANOVA and chi-square test were applied for descriptive group comparisons. Binary logistic regression was performed to estimate associations between multi-level perceived socio-ecological risk and health risk behaviors. Demographic covariates covered gender, only-child status, residential areas, learning period, parental education, family economic status, number of friends and study burden. Results After adjusting for confounding factors, compared with participants in the low-risk group for total socio-ecological risk, participants in the high-risk group showed positive association between irregular diet ( OR : 4.021, 95% CI : 3.145–5.141), lack of physical exercise ( OR : 1.779, 95% CI : 1.400–2.262), short sleep time (weekday: OR : 1.475, 95% CI : 1.059–2.056, weekend: OR : 1.287, 95% CI : 1.048–1.580), long screen time (weekday: OR : 1.399, 95% CI : 1.090–1.797, weekend: OR : 2.086, 95% CI : 1.678–2.592), smoking ( OR : 3.964, 95% CI : 2.894–5.428) and drinking ( OR : 3.662, 95% CI : 2.321–5.778) and high social-ecological risk. The higher the risk of social-ecological risk, the higher the risk of developing health risk behaviors. Conclusion The results supported the importance of investigating health risk behaviors in adolescents and the health risk behaviors were associated with socio-ecological risk