Abstract
INTRODUCTION: Parent-adolescent relationships play a crucial role in influencing high-risk behaviors among adolescents. In Malaysia, there is limited research exploring the influence of parent-adolescent relationships on adolescent risk behaviors. This study aims to determine the role of parent-adolescent connectedness and parental monitoring against high-risk behaviors among Malaysian adolescents. METHODS: This study utilized data from the National Health and Morbidity Survey (NHMS) 2022: Adolescent Health Survey, a cross-sectional study conducted from June to July 2022 among secondary school students. A two-stage stratified cluster sampling method was applied using a national sampling frame of 2,798 schools to ensure state and national representativeness. The Global School-based Student Health Survey (GSHS) Malaysian version was used to collect data on health risk behavior and protective factors including parent-adolescent connectedness and parental monitoring. Descriptive analysis and multivariable logistic regression were used to analyzed the data. RESULTS: Among 33,523 adolescents, a total of 24.2% (95% CI: 23.7-24.7) of adolescents reported parental connectedness, while 33.4% (95% CI: 32.9-33.9) reported parental monitoring. By sociodemographic factors, Indians ethnicity had the highest odds of reporting both parental connectedness (aOR: 1.94, 95% CI: 1.65, 2.28) and parental monitoring (aOR: 2.21, 95% CI: 1.82, 2.70), while adolescents in Labuan Federal Territory (a federally administered island region of Malaysia) had significantly lower odds for both measures. Adolescents with parents married and living together had significantly higher odds of reporting both parental connectedness (aOR: 1.28, 95% CI: 1.18, 1.40) and parental monitoring (aOR: 1.35, 95% CI: 1.26, 1.44). Parental connectedness and monitoring were strong protective factors against all eight high-risk behaviors, including reduced odds of sexual activity (aOR: 0.63 and 0.58), e-cigarette use (aOR: 0.68 and 0.55), smoking, drug use, alcohol use, physical fights, being bullied, and cyberbullying. CONCLUSION: This study found that parental connectedness and monitoring were significantly associated with lower odds of engaging in high-risk behaviors among Malaysian adolescents, with notable variations by ethnicity, parental marital status, and region. Strengthening parental involvement and addressing disparities in family dynamics are essential strategies for promoting adolescent health and well-being in Malaysia.