Abstract
BACKGROUND: Adolescent health-risk behaviors are prevalent and tend to co-occur. This study aimed to identify patterns of health-risk behaviors among Chinese adolescents during the COVID-19 pandemic and explore the effects of individual and social factors on health-risk patterns. METHODS: This cross-sectional study investigated 1607 adolescents from four high schools in 2021 through stratified cluster random sampling. Latent class analysis was conducted to identify patterns of health-risk behaviors and logistic regression was used to examine the risk and protective factors of latent class membership. RESULTS: Four latent classes were identified: "Low risk" (81.6%), "Problematic Internet use" (7.8%), "Alcohol use" (8.5%), and "High risk" (2.1%). Relative to the "Low risk", adolescents with higher levels of sensation seeking, deviant peer affiliation, and childhood abuse were more likely to be assigned to the "Problematic Internet use" class, while those with high degrees of parental monitoring and school connectedness were less likely to be in the "Problematic Internet use" class. Those with higher levels of sensation seeking and deviant peer affiliation, lower scores of parental monitoring and school connectedness were more likely to be assigned to the "Alcohol use" class, compared to the "Low risk". Students in the "High risk" class were more likely to report higher levels of sensation seeking, deviant peer affiliation, and childhood abuse, but lower degrees of parental monitoring and school connectedness than the "Low risk" class. CONCLUSIONS: This study identified patterns of multiple risk behaviors among Chinese high school students during the COVID-19 pandemic and found that multi-level individual and social factors affected latent classes of adolescent health-risk behaviors. These findings provide clues for designing effective interventions to reduce health-risk behaviors among adolescents.