Adolescents’ multiple and individual risk behaviors: Examining the link with excessive sugar consumption across 26 industrialized countries

Rationale: Despite the public health importance and policy relevance, no cross-national studies using large representative samples of adolescents have examined the relationship between high sugar consumption and involvement in risk behaviors. Objective: The current study examines the relationship between high sugar consumption, in the form of sweets and chocolates and non-diet soft drinks, and involvement in peer violence and substance use. It also examines whether any such relationship is moderated by low socio-economic status (SES) and psychological well-being. Method: The study included representative samples of 11-, 13- and 15-year olds in 26 countries (N = 137,284) using data from the Health Behaviors in School Aged Children (HBSC) 2013-14 study. The analysis involved multivariate logistic regression to predict involvement in both individual risk behaviors (physical fighting, bullying, cigarette use, alcohol use, and drunkenness) and multiple risk. Results: This study showed strong and consistent relationships between high sugar consumption and multiple and individual risk behaviors across 26 countries. With the exception of few countries, this relationship did not vary by family SES and adolescents’ psychological health measured through psychosomatic health and life satisfaction, which had strong independent associations with multiple and individual risk behaviors. In the majority of countries, the association between high sugar consumption and multiple risk behavior was driven to a greater extent by the sugary drinks rather than sweets. Conclusions: Findings suggest that unhealthy nutrition such as the intake of large quantities of sugary drinks and sweets and chocolates could be seen as a “red flag” signaling potential involvement in multiple risk behaviors.