title: Chaos, Hubbub, and Order Scale and Health Risk Behaviors in Adolescents in Los Angeles.
abstract: OBJECTIVE
  To determine the relationship between household chaos and substance use, sexual activity, and violence-related risk behaviors in adolescents.
  
  
  METHODS
  We analyzed cross-sectional data among 929 high-school students in Los Angeles who completed a 90-minute interview that assessed health behaviors and household chaos with the 14-question Chaos, Hubbub, and Order Scale (CHAOS). Using the generalized estimating equation and adjusting for personal, parental, and family covariates, we examined associations of CHAOS score with substance use, sexual activity, and violent behavior outcome variables. We also examined the role of depression and school engagement as mediators.
  
  
  RESULTS
  Mean (SD) age of the 929 students was 16.4 (1.3) years, 516 (55%) were female, and 780 (84%) were Latino. After adjustment, compared with students with CHAOS score 0, those students with the greatest scores (5-14) had ORs of 3.1 (95% CI 1.1-8.7) for smoking, 2.6 (95% CI 1.6-4.4) for drinking, 6.1 (95% CI 1.8-21) for substance use at school, and 1.9 (95% CI 1.1-3.3) for fighting in the past 12 months. Associations between CHAOS score and sexual risk and other violent behaviors were not significant. Depression and school engagement attenuated the associations.
  
  
  CONCLUSIONS
  In this group of adolescents, greatest CHAOS score was associated with increased odds of risky health behaviors, with depression and school engagement as potential mediators. In the future, CHAOS score could be measured to assess risk for such behaviors or be a target for intervention to reduce chances of engaging in these behaviors.
authors.affiliation: Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA. Electronic address: avc031@mail.harvard.edu.
authors.forename: Avik
authors.initials: A
authors.lastname: Chatterjee
authors.affiliation: Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Gillman
authors.affiliation: Division of General Internal Medicine, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA.
authors.forename: Mitchell D
authors.initials: MD
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006801:Humans; D015141:Los Angeles; D008297:Male; D012307:Risk Factors; D012309:Risk-Taking; D012574:Schools; D013334:Students / Q000523:psychology*