Social, psychological and biological determinants of risk behaviors among adolescents: a Tunisian cross-sectional study

Background

Adolescence is a transition period where individuals often explore their boundaries through risk-taking behavior such as smoking behaviors, drug use or alcohol consumption. Some of them can have long- and short-term negative consequences. These behaviors can be explained by biological, social and psychological factors. However, exposure to violence is often overlooked when these other determinants are present. The aim of this study is to identify factors associated to risk behaviors among Tunisian adolescents.

Methods

This was a cross-sectional observational study conducted in November 2023 in two middle schools in Tunis, Tunisia. The target population consisted of adolescents enrolled in these two schools. All students who were registered in the 9th year of education, aged 15 years and older, present on the day of the survey and who provided consent, were included. Data was collected using a self-administered paper-based questionnaire in Arabic, completed by the students. The questionnaire assessed psychological, social factors and risk behaviors. Risk behaviors were defined as the presence of at least one of the following: smoking behaviors, drug or alcohol use. Social factors were represented by family relationships and friends’ relationship satisfaction and exposure to violence including environment violence, being a victim of violence, sexual harassment or bullying. Psychological factors were defined by feeling of sadness and despair, loneliness, anhedonia, impulsiveness and expressive ability. Univariate and multivariate analyses were performed to identify factors associated with risky behaviors.

Results

This study included 203 students with female predominance (sex ratio Male/Female=0.7). The overall prevalence of risky behaviors was 37.9%. In univariate analysis, male sex was moderately associated with increased risky behaviors (p=0.012). Exposure to violence was highly associated with it. Being a victim of sexual harassment or violence in all their forms (verbal, psychological, or physical), as well as experiences of bullying, showed the highest level of significance (all factors having a p<0.001). Similarly, witnessing violence within the close environment, including physical or verbal aggression, was also highly associated with these behaviors (p<0.001). Among social determinants, dissatisfaction with family relationships was a significant factor (p=0.001). Regarding psychological determinants, anhedonia showed the strongest association (p<0.001), followed by feelings of sadness and despair (p=0.002).In the multivariate analysis, sexual harassment remained the most relevant independent factor associated with risky behaviors (OR=13, p=0.005). Male sex was the second factor (OR=3.8, p=0.004). Being a victim of violence also remained independently associated (OR=2.51, p=0.03). Among psychological factors, sadness and despair (OR=2.97, p=0.022) and anhedonia (OR=2.8, p=0.023) were identified as independently associated with these risky behaviors.

Conclusions

This study demonstrated that adolescent risk behaviors result from interactions between psychological, social and biological factors. These behaviors contribute to cognitive impairment, reinforcing this vicious cycle. This highlights the need for a comprehensive preventive approach that goes beyond individual behavior and addresses the broader environment. Interventions should focus on promoting safe and supportive settings, particularly in schools, while strengthening access to early psychological support for adolescents.

References

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