title: Clustering of health-related behaviors, health outcomes and demographics in Dutch adolescents: a cross-sectional study.
abstract: BACKGROUND
  Recent studies show several health-related behaviors to cluster in adolescents. This has important implications for public health. Interrelated behaviors have been shown to be most effectively targeted by multimodal interventions addressing wider-ranging improvements in lifestyle instead of via separate interventions targeting individual behaviors. However, few previous studies have taken into account a broad, multi-disciplinary range of health-related behaviors and connected these behavioral patterns to health-related outcomes. This paper presents an analysis of the clustering of a broad range of health-related behaviors with relevant demographic factors and several health-related outcomes in adolescents.
  
  
  METHODS
  Self-report questionnaire data were collected from a sample of 2,690 Dutch high school adolescents. Behavioral patterns were deducted via Principal Components Analysis. Subsequently a Two-Step Cluster Analysis was used to identify groups of adolescents with similar behavioral patterns and health-related outcomes.
  
  
  RESULTS
  Four distinct behavioral patterns describe the analyzed individual behaviors: 1- risk-prone behavior, 2- bully behavior, 3- problematic screen time use, and 4- sedentary behavior. Subsequent cluster analysis identified four clusters of adolescents. Multi-problem behavior was associated with problematic physical and psychosocial health outcomes, as opposed to those exerting relatively few unhealthy behaviors. These associations were relatively independent of demographics such as ethnicity, gender and socio-economic status.
  
  
  CONCLUSIONS
  The results show that health-related behaviors tend to cluster, indicating that specific behavioral patterns underlie individual health behaviors. In addition, specific patterns of health-related behaviors were associated with specific health outcomes and demographic factors. In general, unhealthy behavior on account of multiple health-related behaviors was associated with both poor psychosocial and physical health. These findings have significant meaning for future public health programs, which should be more tailored with use of such knowledge on behavioral clustering via e.g. Transfer Learning.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, STR, 6,131, Postbus 85500, 3508 GA, Utrecht, The Netherlands. v.busch@umcutrecht.nl.
authors.forename: Vincent
authors.initials: V
authors.lastname: Busch
authors.forename: Henk F
authors.initials: HF
authors.lastname: Van Stel
authors.forename: Augustinus J P
authors.initials: AJ
authors.lastname: Schrijvers
authors.forename: Johannes R J
authors.initials: JR
authors.lastname: de Leeuw
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D058445:Bullying / Q000523:psychology; D002648:Child; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data; D008297:Male; D009426:Netherlands; D012307:Risk Factors; D012309:Risk-Taking; D057185:Sedentary Behavior; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013690:Television / Q000706:statistics & numerical data; D018910:Video Games / Q000523:psychology