Abstract Objective To assess the simultaneity of risk behaviors for chronic non-communicable diseases and their association with individual and contextual characteristics in Brazilian adolescents. Methods Cross-sectional study using data from the 2019 Brazilian National Health Survey. The simultaneity of factors of the consumption of ultra-processed foods, level of physical activity, smoking and alcohol use was analyzed, according to individual and contextual characteristics, estimating the odds ratios (OR) and respective 95% confidence intervals (95%CI) for fixed effects and variance and 95%CI for random effects, through multilevel polytomous logistic regression. Results Among the 4,336 adolescents evaluated, the most prevalent combination of two risk behaviors included the consumption of ultra-processed foods and insufficient level of physical activity (13.3%; 95%CI 11.6; 15.3). The most frequent combination of three factors included these behaviors combined with habitual alcohol use (3.6%; 95%CI 2.7; 4.8). The chances of combinations of three or four factors were lower in females (OR 0.44; 95%CI 0.32; 0.60) and in rural areas (OR 0.46; 95%CI 0.31; 0.70) and higher in older adolescents (OR 2.57; 95%CI 1.72; 3.83), with higher levels of education (OR 8.11; 95%CI 2.41; 27.26) and living without partners (OR 3.83; 95%CI 1.10; 13.35). High Human Development Indices increased these chances (OR 7.28; 95%CI 3.81; 13.92), while high Social Vulnerability Indices (OR 0.25; 95%CI 0.11; 0.58) and Gini Indices (OR 0.28; 95%CI 0.15; 0.52) reduced them. Conclusion The occurrence of multiple risk behaviors in adolescents is more likely among older, male, single and more educated adolescents, especially in areas of greater socioeconomic development.
Silva et al. (2025) studied this question.