title: Clustering of chronic disease behavioral risk factors in Canadian children and adolescents.
abstract: OBJECTIVE
  We assessed the prevalence, socioeconomic distribution and clustering of five major chronic disease behavioral risk factors (physical inactivity, sedentary behavior, tobacco smoking, alcohol drinking and high body mass index) in a representative sample of Canadian children and adolescents aged 10-17 years.
  
  
  METHODS
  Cross-sectional data (n=4724) from Cycle 4 (2000/2001) of the National Longitudinal Survey of Children and Youth were used. Clustering was assessed using an observed to expected ratio method.
  
  
  RESULTS
  Overall, 65% of Canadian youth had two or more behavioral risk factors compared to only 10% with none of the five risk factors. The prevalence of having multiple behavioral risk factors was greater among older youth and those from low socioeconomic status families. Behavioral risk factors clustered in multiple combinations. Specifically, the simultaneous occurrence of all five risk factors was 120% greater in males (Observed/Expected ratio: 2.20; 95% CI: 1.31-3.09) and 94% greater in females (Observed/Expected ratio: 1.94; 95% CI: 1.24-2.64) than expected. Ever smoking and ever drinking showed the strongest association among the pairwise clusters.
  
  
  CONCLUSIONS
  Multiple chronic disease behavioral risk factors are frequent and occur more often than expected among Canadian children and adolescents. Early prevention programs targeting clusters of behavioral risk factors in youth are needed.
authors.affiliation: National Public Health Institute of Quebec, Montreal, Quebec, Canada. arsham.alamian@umontreal.ca
authors.forename: Arsham
authors.initials: A
authors.lastname: Alamian
authors.forename: Gilles
authors.initials: G
authors.lastname: Paradis
mesh_terms: D000293:Adolescent; D002170:Canada / Q000453:epidemiology; D002648:Child; D002908:Chronic Disease / Q000453:epidemiology*; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012307:Risk Factors; D012309:Risk-Taking; D011795:Surveys and Questionnaires