# Clustering of adolescents’ health behaviors before and during the COVID-19 pandemic: examining transitions and the role of demographics and parental health behaviors

## TL;DR

This study explores how adolescents' health behaviors clustered before and during the pandemic, finding that some remained at risk for unhealthy behaviors.

## Contribution

The novel contribution is identifying transitions in health behavior clusters during pandemic phases and linking these to demographics and parental behaviors.

## Key findings

- Three health behavior classes were identified before the pandemic, with transitions observed during pandemic phases.
- Parental food intake behaviors were linked to transitions from a medium-risk to a high-risk health behavior class.
- Most adolescents retained their health behavior class during the pandemic, suggesting stability in risk profiles.

## Abstract

The COVID-19 pandemic and its measures have profoundly affected adolescents’ lives, including their health behaviors. As a host of research indicates that adolescent health behaviors cluster together and that adolescents can respond differently to the pandemic, we examined adolescents’ changes in clusters of health behaviors and its correlates during different phases of the pandemic.

A total of 710 Dutch adolescents (53% female; at pre-pandemic: Mage = 14.37; SDage = 0.65; age range = 12.72 to 17.06 years) completed questionnaires on health behaviors (i.e., nicotine use, alcohol use, unhealthy food intake, and physical inactivity) before the pandemic (spring 2019) and during different phases of the pandemic (lockdown 1 (spring 2020), reopening 1 (fall 2020), lockdown 2 (spring 2021), reopening 2 (fall 2021)). We used a person-centered technique to explore how health behaviors clustered in latent classes before and during different phases of the pandemic, and whether adolescents transitioned to different classes during different phases. Adolescent demographics (i.e., age, educational type, and sex) and parental health behaviors were tested as covariates of class membership and transitions.

The Latent Transition Analysis (LTA) identified three classes before the pandemic: one class characterized by health-risk substance use and food intake, one class characterized by health-protective versions of these behaviors, and a medium health-risk class. During the pandemic phases, two classes were identified: most adolescents in the health-risk or health-protective class transitioned to a class with similar health-risk and health-protective behaviors. The third, medium health-risk, class was split into a health-protective and a health-risk class during the pandemic, with most adolescents transitioning to the health-risk class. Age, educational type, sex, and parental food intake behavior were related to latent class membership at some, but not all, time points. Some parental health behaviors, but not adolescent demographic factors, were related to the transition from the medium health-risk to the health-risk class.

Adolescents at-risk for unhealthy behaviors may remain so during the pandemic. Adolescent demographics and parental (food intake) behaviors are relevant to consider as forms of screening adolescents who may be more at risk to show health-risk behaviors. Larger studies are needed to corroborate these findings.

The online version contains supplementary material available at 10.1186/s12889-025-25368-3.