Published: 2021-05-25

Patterns of lifestyle risk behaviors among Saudi Arabian school students

Saeed G. Alzahrani


Background: Lifestyle risk behaviours initiated at a young age tend to remain in adulthood. Clustering of lifestyle risk behaviours has negative cumulative effects on health. The aim of this study was to examine patterns of clustering lifestyle risk behaviours (smoking, physical inactivity, high sugars intake, low fruits and vegetables intake, and infrequent tooth brushing) among younger and older Saudi male adolescents.

Methods: A stratified cluster random sample of 1213 Saudi Arabian male school students living in Riyadh city answered adapted WHO health behaviour in school-aged children (HBSC) questionnaire on health-related behaviours. The patterns of clustering lifestyle risk behaviours were assessed using an observed to expected ratio (O/E) method.

Results: The results showed that 10 (in older adolescents) and 09 (in younger adolescents) out of 27 combinations of lifestyle risk behaviors clustered. The combination of three risk behaviors (smoking, physical inactivity and high sugars intake) clustered with the highest O/E ratio of 3.16 among younger adolescents, while the combination of (smoking, high sugars intake and low fruits/vegetables intake) was among older adolescents with O/E: of 1.67.

Conclusions: The current study identifies patterns of clustering lifestyle risk behaviours among younger and older Saudi male adolescents. Identification of these patterns is important for health promotion interventions.


Patterns, Clustering, Lifestyle, Health-related behaviours, Adolescents

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Beaglehole R, Bonita R, Horton R, Adams C, Alleyne G, Asaria P et al. Priority actions for the non-communicable disease crisis. The Lancet. 2011;377(9775):1438-47.

Islam SMS, Purnat TD, Phuong NTA, Mwingira U, Schacht K, Fröschl G. Non‐Communicable Diseases (NCDs) in developing countries: a symposium report. Globalization Health. 2014;10:1.

Patterson RE, Haines PS, Popkin BM. Health lifestyle patterns of U.S. adults. Prev Med. 1994;23(4):453-60.

Aaro LE, Laberg JC, Wold B. Health Behaviors Among Adolescents-Towards A Hypothesis of 2 Dimensions. Health Education Res. 1995;10(1):83-93.

Schuit AJ, van Loon AJ, Tijhuis M, Ocke M. Clustering of lifestyle risk factors in a general adult population. Prev Med. 2002;35(3):219-24.

Myint PK, Luben RN, Wareham NJ, Bingham SA, Khaw KT. Combined effect of health behaviours and risk of first ever stroke in 20040 men and women over 11 years' follow-up in Norfolk cohort of European Prospective Investigation of Cancer (EPIC Norfolk): prospective population study. BMJ 2009. 2009;338: b349.

Mikkila V, Rasanen L, Raitakari OT, Pietinen P, Viikari J. Consistent dietary patterns identified from childhood to adulthood: the cardiovascular risk in Young Finns Study. Br J Nutr. 2005;93(6):923-31.

Laaksonen M, Prattala R, Karisto A. Patterns of unhealthy behaviour in Finland. EurJ Public Health. 2001;11(3):294-300.

Alamian A, Paradis G. Correlates of Multiple Chronic Disease Behavioral Risk Factors in Canadian Children and Adolescents. Am J Epidemiol. 2009;170(10):1279-89.

AlBuhairan FS, Tamim H, Al Dubayee M, AlDhukair S, Al Shehri S, Tamimi W et al. Time for an Adolescent Health Surveillance System in Saudi Arabia: Findings From "Jeeluna". J adolescent health. 2015;57(3):263-9.

Al-Hazzaa HM, Abahussain NA, Al-Sobayel HI, Qahwaji DM, Musaiger AO. Physical activity, sedentary behaviors and dietary habits among Saudi adolescents relative to age, gender and region. Int J Behavioral Nutr Physical Activity. 2011;8(1):140.

WHO. Adolescent Friendly Health Services. Geneva: World Health Organization. 2002. Available at: Accessed on 20 March 2021.

Currie C, Samdal O, Boyce W, Smith B. Health Behaviour in School-Aged Children: a World Health Organisation Cross-National Study. Research Protocol for the 2001/02 Survey. 2002.

Petridou E, Zavitsanos X, Dessypris N, Frangakis C, Mandyla M, Doxiadis S et al. Adolescents in high-risk trajectory: clustering of risky behavior and the origins of socioeconomic health differentials. Prev Med. 1997;26(2):215-9.

WHO. Global recommendations on physical activity for health. Geneva: WHO; 2010. Available at: Accessed on 20 March 2021.

Ebrahim S, Montaner D, Lawlor DA. Clustering of risk factors and social class in childhood and adulthood in British women's heart and health study: cross sectional analysis. BMJ. 2004;328(7444):861.

Lawrence EM, Mollborn S, Hummer RA. Health lifestyles across the transition to adulthood: Implications for health. Social Sci Med. 2017;193:23-32.

Jordão LMR, Malta DC, Freire M. Clustering patterns of oral and general health-risk behaviours in Brazilian adolescents: Findings from a national survey. Community Dent Oral Epidemiol. 2018;46(2):194-202.

Torabi MR, Bailey WJ, Majd-Jabbari M. Cigarette Smoking as a Predictor of Alcohol and Other Drug Use by Children and Adolescents: Evidence of the "Gateway Drug Effect". J School Health. 1993;63(7):302-6.

Rocha FL, Velasquez-Melendez G. Simultaneity and aggregation of risk factors for noncommunicable diseases among brazilian adolescents. Escola Anna Nery. 2019;23(3).

Brener ND, Collins JL, Kann L, Warren CW, Williams BI. Reliability of the Youth Risk Behavior Survey Questionnaire. Am J Epidemiol. 1995;141(6):575-80.

Smeets T, Kremers S, de Vries H, Brug J. Effects of tailored feedback on multiple health behaviors. Ann Behavioral Med. 2007;33(2):117-23.

WHO. Report On the Global Tobacco Epidemic. Geneva: World Health Organization; 2008. Available at: Accessed on 25 March 2021.

WHO. Diet, nutrition and the prevention of chronic diseases. Report of the joint WHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases. Geneva: World Health Organization; 2003. Available at: Accessed on 25 March 2021.

WHO/FAO. Fruit and vegetables for health: Report of a joint FAO/WHO Workshop. Geneva: WHO/FAO; 2005. Available at: Accessed on 25 March 2021.

Loe H. Oral hygiene in the prevention of caries and periodontal disease. Int Dent J. 2000;50(3):129-39.

Teh CH, Teh MW, Lim KH, Kee CC, Sumarni MG, Heng PP, et al. Clustering of lifestyle risk behaviours and its determinants among school-going adolescents in a middle-income country: a cross-sectional study. BMC Public Health. 2019;19(1).