title: Individual and social determinants of multiple chronic disease behavioral risk factors among youth.
abstract: BACKGROUND
  Behavioral risk factors are known to co-occur among youth, and to increase risks of chronic diseases morbidity and mortality later in life. However, little is known about determinants of multiple chronic disease behavioral risk factors, particularly among youth. Previous studies have been cross-sectional and carried out without a sound theoretical framework.
  
  
  METHODS
  Using longitudinal data (n = 1135) from Cycle 4 (2000-2001), Cycle 5 (2002-2003) and Cycle 6 (2004-2005) of the National Longitudinal Survey of Children and Youth, a nationally representative sample of Canadian children who are followed biennially, the present study examines the influence of a set of conceptually-related individual/social distal variables (variables situated at an intermediate distance from behaviors), and individual/social ultimate variables (variables situated at an utmost distance from behaviors) on the rate of occurrence of multiple behavioral risk factors (physical inactivity, sedentary behavior, tobacco smoking, alcohol drinking, and high body mass index) in a sample of children aged 10-11 years at baseline. Multiple behavioral risk factors were assessed using a multiple risk factor score. All statistical analyses were performed using SAS, version 9.1, and SUDAAN, version 9.01.
  
  
  RESULTS
  Multivariate longitudinal Poisson models showed that social distal variables including parental/peer smoking and peer drinking (Log-likelihood ratio (LLR) = 187.86, degrees of freedom (DF) = 8, p < .001), as well as individual distal variables including low self-esteem (LLR = 76.94, DF = 4, p < .001) increased the rate of occurrence of multiple behavioral risk factors. Individual ultimate variables including age, sex, and anxiety (LLR = 9.34, DF = 3, p < .05), as well as social ultimate variables including family socioeconomic status, and family structure (LLR = 10.93, DF = 5, p = .05) contributed minimally to the rate of co-occurrence of behavioral risk factors.
  
  
  CONCLUSIONS
  The results suggest targeting individual/social distal variables in prevention programs of multiple chronic disease behavioral risk factors among youth.
authors.affiliation: Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA. alamian@etsu.edu
authors.forename: Arsham
authors.initials: A
authors.lastname: Alamian
authors.forename: Gilles
authors.initials: G
authors.lastname: Paradis
mesh_terms: D000293:Adolescent; D000428:Alcohol Drinking / Q000453:epidemiology / Q000523:psychology; D002170:Canada / Q000453:epidemiology; D002648:Child; D002908:Chronic Disease / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D010287:Parent-Child Relations; D010379:Peer Group; D016012:Poisson Distribution; D015995:Prevalence; D012307:Risk Factors; D057185:Sedentary Behavior; D012907:Smoking / Q000453:epidemiology / Q000523:psychology; D012931:Social Environment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires