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Summary Van Nieuwenhuijzen et al.
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Van Nieuwenhuijzen et al.ABSTRACT
Objective. This study investigates the clustering of a broad range of health-compromising
and delinquent behaviors. We examine whether these behaviors belong to a single but broad
cluster, ‘risk-taking behavior’, and whether the nature and degree of clustering in adolescents
differs from that in adults. Method. A representative sample (N= 4395) of the Dutch
population aged 12 to 40 (overall response rate 67%), was asked about various health-
compromising behaviors, such as alcohol consumption, smoking, illegal drug use, unsafe
sexual behavior, physical inactivity, poor nutrition (such as skipping breakfast and not eating
fruit and vegetables), poor sleep behavior, unlawful traffic behavior, and delinquent and
aggressive behavior. Data were collected from fall 2005 to spring 2006 using internet
questionnaires and face-to-face computer-assisted interviews. Results. No single broad
cluster was found. Instead, there were several separate but interrelated clusters. The
contents of these clusters differed between age groups. For young adolescents (12–15) two
clusters were identified: Alcohol and Delinquency. For older adolescents (16–18) and adults
(19–40) three clusters were identified: Alcohol, Delinquency and Health. Conclusion. The
findings of this study support a more integrated approach to promoting healthier lifestyles,
and suggest that the behavior targets of integrated prevention programs should be different
for adolescents and adults.
The aim of this study was to establish whether health-compromising behaviors and
delinquent behaviors belonged to one broad cluster (‘risk-taking behavior’), and whether this
clustering differed by age. The results suggest that clustering occurs but in several
interrelated clusters, and that the type of clustering differs by age and sex.
In young adolescents (age 12–15), there was a broad cluster of risk-taking behavior,
and a second cluster that consisted of alcohol, smoking and drug abuse. This
probably reflects the life phase in which young adolescents experiment with
substances and confirms earlier findings.
In late adolescence (age 16–18), risk-taking behaviors were found to concern three,
different, clusters. Alcohol clustered with unsafe sex, unlawful traffic behavior and
vigorous physical activity.
o The move of use of alcohol to a cluster not containing delinquent behaviors
such as vandalism and aggressive behavior may be due to the gradually more
permissive social norm setting in our society concerning the use of alcohol.
o The association of use of alcohol with other health endangering behaviors
such as unsafe sex more closely reflects the pattern in adults. This change in
patterns of clustering can be explained from a developmental perspective:
experimenting with smoking and alcohol in adolescence is norm-breaking,
whereas it is accepted in adulthood. Similarly, using hard drugs is more
common in late adolescence than in adulthood, where it is more associated to
delinquent behaviors.
The second cluster in late adolescence comprised aggressive behavior, smoking,
drug use, little sleep and delinquency. An explanation may be that drug use and
smoking in late adolescence are not just a continuation of the experimental use of
substances typical in younger adolescents. The adolescents that continue this use,
do it as part of a more general delinquent lifestyle, which is related to the use of
alcohol.
For adults (19–40 years), the pattern of health-compromising and delinquent behavior
seems to be crystallized. ‘Health-protective behaviors’ co-occur and surprisingly,
smoking as a health-endangering behavior is also part of this cluster. The
Delinquency-adults cluster seems to be the final stage of a move of behaviors
between clusters that has already started in late adolescence, leading in adulthood to
a cluster that fully consists of behaviors that are considered as normbreaking in most
industrialized societies.
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