Background Most studies on multiple health risk behaviors among adolescents have cross-sectionally studied a limited number of health behaviors or determinants.
Purpose To examine the prevalence, longitudinal patterns and predictors of individual and multiple health risk behaviors among adolescents.
Methods Eight health risk behaviors (no regular consumption of fruit, vegetables or breakfast, overweight or obesity, physical inactivity, smoking, alcohol use and cannabis use) were assessed in a prospective population study (second and third wave). Participants were assessed in three waves between ages 10 and 17 (2001-2008; n = 2230). Multiple linear regression was used to assess the influence of gender, self-control, parental health risk behaviors, parental monitoring and socioeconomic factors on the number of health risk behaviors adjusted for preceding multiple health risk behaviors (analysis: 2013-2014).
Results Rates of >. 5 health risk behaviors were high: 3.6% at age 13.5 and 10.2% at age 16. Smoking at age 13.5 was frequently associated with health risk behaviors at age 16. No regular consumption of fruit, vegetables and breakfast, overweight or obesity, physical inactivity and smoking predicted the co-occurrence of health risk behaviors at follow-up. Significant predictors of the development of multiple health risk behaviors were adolescents' levels of self-control, socioeconomic status and maternal smoking.
Conclusions Multiple health risk behaviors are common among adolescents. Individual and social factors predict changes in multiple health risk behaviors, showing that prevention targeting multiple risk behaviors is needed. Special attention should be paid to adolescents with low self-control and families with low socioeconomic status or a mother who smokes.

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Keywords Adolescence, Longitudinal study, Multiple health risk behaviors, Parental health behaviors, Self-control, Social factors
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Journal Preventive Medicine
de Winter, A.F, Visser, L, Verhulst, F.C, Vollebergh, W.A.M, & Reijneveld, S.A. (2016). Longitudinal patterns and predictors of multiple health risk behaviors among adolescents: The TRAILS study. Preventive Medicine, 84, 76–82. doi:10.1016/j.ypmed.2015.11.028