Individual and social determinants of multiple chronic disease behavioural risk factors in Canadian children and adolescents

Background: Behavioural risk factors including physical inactivity, sedentary behaviour, cigarette smoking, alcohol drinking, and being overweight are major modifiable causes of chronic diseases such as cancer, cardiovascular diseases and diabetes. These lifestyle risk factors also co-occur in individuals and lead to increased risks of chronic diseases morbidity and mortality. Although single behavioural risk factors have been extensively studied, little is known about the distribution, clustering patterns and potential determinants of multiple behavioural risk factors for chronic diseases, particularly in children and adolescents.  Objectives: This thesis aims 1) to describe the prevalence and clustering patterns of multiple chronic disease behavioural risk factors in Canadian children and adolescents; 2) to explore potential individual, social and school correlates of multiple chronic disease behavioural risk factors in Canadian children and adolescents; and 3) to assess, based on the conceptual framework of this study, the longitudinal influence of selected individual (sense of self, sense of achievement), social (social relations, others’ behaviours) and school (collective commitment to success, comprehension of rules) distal variables (variables situated at an intermediate distance from behaviours), as well as selected individual (demographics and personality traits), social (parental socioeconomic characteristics) and school (type of school, supportive environment, disciplinary climate) ultimate variables (variables situated at an utmost distance from behaviours) on the rate of occurrence of multiple chronic disease behavioural risk factors in Canadian children and adolescents.  Methods: Cross-sectional data (n = 4724) from Cycle 4 (2000-2001) of the National Longitudinal Survey of Children and Youth (NLSCY) were used to describe the prevalence and clustering patterns of multiple behavioural risk factors in Canadian youth aged 10-17 years. Clustering was assessed using an observed to expected ratio method. Ordinal logistic regression was used to explore correlates of multiple behavioural risk factors in a cross-sectional sample (n = 1747) of Canadian youth aged 10-15 years from Cycle 4 (2000-2001) of the NLSCY. Prospective data (n = 1135) from Cycle 4 (2000-2001), Cycle 5 (2002-2003) and Cycle 6 (2004-2005) of the NLSCY were used to assess the longitudinal influence of selected distal and ultimate variables (as described above in the objectives) on the rate of occurrence of multiple behavioural risk factors in Canadian youth aged 10-15 years; this analysis was performed using longitudinal Poisson models. Results: Sixty-five percent of Canadian youth had two or more behavioural risk factors compared to only 10% with no risk factor. Behavioural risk factors clustered in multiple combinations. Specifically, the simultaneous occurrence of all five risk factors was 120% greater in males (observed/expected (O/E) ratio = 2.20, 95% confidence interval (CI): 1.31-3.09) and 94% greater in females (O/E ratio = 1.94, 95% CI: 1.24-2.64) than expected by chance. Older age (odds ratio (OR) = 1.95, 95% CI: 1.21-3.13), caregiver smoking (OR = 1.49, 95% CI: 1.09-2.03), reporting that most/all of one’s peers smoked (OR = 7.31, 95% CI: 4.00-13.35) or drank alcohol (OR = 3.77, 95% CI: 2.18-6.53), and living in a lone-parent family (OR = 1.94, 95% CI: 1.31-2.88) increased the likelihood of having multiple health risk behaviours. Youth with high self-esteem (OR = 0.92, 95% CI: 0.85-0.99) and youth from families with post-secondary education (OR = 0.58, 95% CI: 0.41-0.82) were less likely to have a higher number of behavioural risk factors. Finally, social distal variables (caregiver smoking, peer smoking, peer drinking) (Log-likelihood ratio (LLR) = 187.86, degrees of freedom = 8, P < 0.001) and individual distal variables (such as self-esteem) (LLR = 76.94, degrees of freedom = 4, P < 0.001) significantly influenced the rate of occurrence of multiple behavioural risk factors. Individual ultimate variables (age, sex, anxiety) and social ultimate variables (parental education, household income, family structure) exerted a less pronounced influence on the rate of co-occurrence of behavioural risk factors among youth. Conclusion: The results suggest that public health interventions should primarily target the individual distal (such as self-esteem) and social distal variables (such as parental smoking, peer smoking and peer drinking) to reduce or prevent the occurrence of multiple behavioural risk factors among youth. However, since distal variables (such as psychosocial characteristics and others’ behaviours) may be influenced by ultimate variables (such as demographic and socioeconomic characteristics), prevention programs and policies should also aim to improve the socioeconomic conditions of children and adolescents, particularly those of youth from less affluent families.

Keyphrases: Adolescent, Epidemiology, Chronic diseases, Adolescent, Child, Multiple risk factors, Health behaviours, Individual determinants, Social determinants