title: Behavioral risk factors and mental health: single and cluster associations in Spanish adolescents.
abstract: OBJECTIVE
  The risk factors associated with mental health in adolescents are not well known in the general population of Mediterranean countries. Therefore, this study aimed to identify individual and clustered behavioral risk factors for psychological distress.
  
  
  METHODS
  Cross-sectional study conducted between 2008 and 2009 among 4054 students representative of those in the fourth year of secondary education in the region of Madrid (Spain). Mental health was assessed using the General Health Questionnaire, with psychological distress defined as a score ≥3. The analyses were performed with logistic regression and adjusted for the main confounders.
  
  
  RESULTS
  Psychological distress was more frequent in those who did insufficient physical activity (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.03-1.47), smokers (OR, 1.30; 95% CI, 1.07-1.59), and users of illegal drugs (OR, 1.46; 95% CI, 1.21-1.76). Psychological distress also showed a positive dose-response relationship with the number of risk behaviors for eating disorders (p for linear trend <0.001). Moreover, it was associated with both thin (OR, 1.37; 95% CI, 1.16-1.62) or very thin body image (OR, 2.15; 95% CI, 1.39-3.32) and perceived overweight (OR, 1.74; 95% CI, 1.40-2.15) or obesity (OR, 3.12; 95% CI, 2.23-4.37). Compared with individuals without classic risk behaviors (low physical activity, low consumption of fruits/vegetables, smoking, high-risk alcohol consumption), frequency of psychological distress was higher in those with 2 risk behaviors (OR, 1.47; 95% CI, 1.19-1.82) and was even greater in those with 3 or 4 risk behaviors (OR, 1.56; 95% CI, 1.21-2.01).
  
  
  CONCLUSIONS
  During adolescence, psychological distress is associated with lifestyles, body image, and eating behaviors. Clustering of classic risk behaviors increases the likelihood of poor mental health.
authors.affiliation: Public Health Centre, Madrid Regional Health Authority, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Padrón
authors.forename: Iñaki
authors.initials: I
authors.lastname: Galán
authors.forename: Fernando
authors.initials: F
authors.lastname: Rodríguez-Artalejo
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000208:ethnology*; D001828:Body Image / Q000523:psychology; D002648:Child; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005247:Feeding Behavior / Q000208:ethnology; D001068:Feeding and Eating Disorders / Q000191:economics / Q000208:ethnology; D005260:Female; D006801:Humans; D008019:Life Style / Q000208:ethnology; D008297:Male; D008603:Mental Health / Q000191:economics / Q000208:ethnology; D012307:Risk Factors; D012309:Risk-Taking; D013030:Spain / Q000208:ethnology; D013315:Stress, Psychological / Q000191:economics / Q000208:ethnology*