[Urban and rural differences in aggregation risk of health risk behaviors among adolescents in Wuling Mountain Area].

Objective: Understanding urban-rural differences in the risk of aggregation of adolescents' health-risk behaviors in the Wuling Mountain Area.

Methods: From March to May 2023, 7901 adolescents from junior to junior high school and senior high school grades in 32 middle schools in 8 counties(districts) in the Wuling Mountain Area were selected as survey respondents using the multi-stage stratified random cluster sampling method, with the age of the survey respondents being(14.82±1.50) years old. There were 4047 male students(51.22%) and 3854 female students(48.78%), 5126(64.88%) in junior high school and 2775(35.12%) in senior high school.2513(31.81%) in rural schools and 5388(68.19%) in urban schools. The Questionnaire on Health Risky Behaviors of Youth in Wuling Mountain Area was used to investigate 9 health risky behaviors of youth, such as partial feeding, smoking, and drinking alcohol. The χ~2 test was used to test the difference between urban and rural adolescents' risky health behaviors and their multivariate aggregation incidence rates, and to calculate the relative risk(RR) and the actual expected ratio(O/E).

Results: The incidence of bivariate to quintivariate cluster of adolescent health-risk behaviors was lower in all rural schools than in urban schools(χ~2 were 60.73, 34.97, 16.89, and 9.14, P<0.05). Rural school adolescents had the highest RR value for alcohol consumption behavior(18.02), while urban school adolescents had the highest RR value for insomnia behavior(15.05). In the bivariate cluster model, the O/E values for "smoking+alcohol consumption" were highest in both rural(8.18) and urban(6.14) school adolescents. In the trivariate cluster model, the O/E values for "smoking+alcohol consumption+fighting" were highest in both rural(28.41) and urban(18.15) school adolescents. In the quadrivariate cluster model, the O/E values for "smoking+alcohol consumption+insomnia+experiencing school bullying" were highest in rural school adolescents(95.10), while the O/E values for "smoking+alcohol consumption+fighting+experiencing school bullying" were highest in urban school adolescents(42.97). In the quintivariate cluster model, the O/E values for "smoking+alcohol consumption+fighting+insomnia+experiencing school bullying" were highest in both rural(309.57) and urban(129.28) school adolescents.

Conclusion: Adolescents in urban schools in the Wuling Mountain Area are more prone to clustering harmful health behaviors compared to those in rural schools, and there are differences in the clustering risks of harmful health behaviors and their diverse clustering patterns between urban and rural areas.