{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T12:01:22Z","timestamp":1780574482115,"version":"3.54.1"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T00:00:00Z","timestamp":1718064000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["208090\/Z\/17\/Z"],"award-info":[{"award-number":["208090\/Z\/17\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/S009868\/1"],"award-info":[{"award-number":["MR\/S009868\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012349","name":"School for Public Health Research","doi-asserted-by":"publisher","award":["NIHR 204000"],"award-info":[{"award-number":["NIHR 204000"]}],"id":[{"id":"10.13039\/501100012349","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Since the early 2000s, there have been marked trends in adolescent health and wellbeing indicators across Europe, North America and Australia. In particular, there have been substantial declines in youth drinking. We know little about how these trends are underpinned by co-occurring indicators within individuals. This paper aims to analyse change over time in how indicators cluster within individuals and differences in these patterns between five countries with different trends in youth drinking.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We analysed four waves of repeat cross-sectional survey data from 15-year-olds in England (n = 5942), Italy (n = 5234), the Netherlands (n = 5408), Hungary (n = 5274), and Finland (n = 7446), which were included in the Health Behaviours in School-aged Children (HBSC) study between 2001\/02 and 2013\/14. We defined clusters of individuals using multigroup latent class analyses which accounts for change over time. The class indicators included health behaviours, attitudes, wellbeing and relationships. We modelled associations between class membership, sex, and family affluence over time.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>We identified four classes in all countries: <jats:italic>Overall unhealthy<\/jats:italic>, <jats:italic>Overall healthy<\/jats:italic>, <jats:italic>Moderately healthy<\/jats:italic> and <jats:italic>Substance abstainers with behaviour risk indicators<\/jats:italic>. The proportion of adolescents in the <jats:italic>Overall unhealthy<\/jats:italic> class declined between 2001\/02 and 2013\/14 by between 22.8 percentage points (pp) in England and 3.2pp in Italy. The extent to which indicators of health and wellbeing changed as linked clusters differed across countries, but changes in alcohol consumption, smoking, drug use and sexual activity were typically concurrent. Adolescents with low family affluence were more likely to be in the <jats:italic>Overall unhealthy<\/jats:italic> class in all years.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Improvements in indicators of adolescent health and well-being are due mainly to concurrent declines in drinking, smoking, sexual activity, and cannabis use, but these declines are not consistently associated with improvements in other domains. They have also not led to reductions in inequalities in indicators of health and well-being.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0305124","type":"journal-article","created":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T18:01:07Z","timestamp":1718128867000},"page":"e0305124","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["A latent class analysis of international change and continuity in adolescent health and wellbeing: A repeat cross-sectional study"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5637-5245","authenticated-orcid":true,"given":"Abigail K.","family":"Stevely","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6365-7710","authenticated-orcid":true,"given":"Laura A.","family":"Gray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Fairbrother","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Fenton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeleine","family":"Henney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8799-8963","authenticated-orcid":true,"given":"Inge","family":"Kersbergen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Holmes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,6,11]]},"reference":[{"key":"pone.0305124.ref001","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-020-10140-6","article-title":"Clustering of health-related behaviours within children aged 11\u201316: a systematic review.","volume":"21","author":"V Whitaker","year":"2021","journal-title":"BMC Public Health."},{"key":"pone.0305124.ref002","article-title":"Clustering of unhealthy behaviours over time: implications for policy and practice.","author":"D Buck","year":"2012"},{"key":"pone.0305124.ref003","doi-asserted-by":"crossref","DOI":"10.1186\/s40814-018-0259-7","article-title":"Adolescents and health-related behaviour: using a framework to develop interventions to support positive behaviours.","volume":"4","author":"J Pringle","year":"2018","journal-title":"Pilot Feasibility Stud"},{"key":"pone.0305124.ref004","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1093\/eurpub\/cku078","article-title":"Multiple risk behaviour in adolescence and socio-economic status: findings from a UK birth cohort","volume":"25","author":"RR Kipping","year":"2015","journal-title":"Eur J Public Health"},{"key":"pone.0305124.ref005","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1007\/s10899-018-09824-x","article-title":"Substance use and gambling patterns among adolescents: Differences according to gender and impulsivity.","volume":"35","author":"V Mart\u00ednez-Loredo","year":"2019","journal-title":"J Gambl Stud."},{"key":"pone.0305124.ref006","doi-asserted-by":"crossref","first-page":"3","DOI":"10.5993\/AJHB.43.1.1","article-title":"Adolescent Tobacco Uptake and Other Substance Use: A Latent Class Analysis.","volume":"43","author":"J Delk","year":"2019","journal-title":"Am J Health Behav."},{"key":"pone.0305124.ref007","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1111\/jpc.13930","article-title":"Downwards trends in adolescent risk-taking behaviours in New Zealand: Exploring driving forces for change.","volume":"54","author":"S Lewycka","year":"2018","journal-title":"J Paediatr Child Health"},{"key":"pone.0305124.ref008","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1093\/eurpub\/ckaa193","article-title":"Trends in adolescent drinking across 39 high-income countries: exploring the timing and magnitude of decline.","volume":"31","author":"R Vashishtha","year":"2020","journal-title":"Eur J Public Health"},{"key":"pone.0305124.ref009","first-page":"1","article-title":"Are changes in attitudes towards school associated with declining youth drinking? A multi-level analysis of 37 countries.","author":"AK Stevely","year":"2022","journal-title":"Eur J Public Health."},{"key":"pone.0305124.ref010","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1080\/16066359.2021.2021402","article-title":"How does technology influence young people\u2019s drinking? A complex relationship in need of innovation.","volume":"30","author":"G Caluzzi","year":"2022","journal-title":"Addict Res Theory"},{"key":"pone.0305124.ref011","doi-asserted-by":"crossref","first-page":"1650","DOI":"10.1093\/ije\/dyz006","article-title":"Changes in millennial adolescent mental health and health-related behaviours over 10 years: a population cohort comparison study.","volume":"48","author":"P Patalay","year":"2019","journal-title":"Int J Epidemiol"},{"key":"pone.0305124.ref012","doi-asserted-by":"crossref","first-page":"102481","DOI":"10.1016\/j.pmedr.2023.102481","article-title":"A latent class analysis of change and continuity in adolescent health and wellbeing in England during the decline in youth alcohol consumption: a repeat cross-sectional study","volume":"36","author":"AK Stevely","year":"2023","journal-title":"Prev Med Reports"},{"key":"pone.0305124.ref013","article-title":"Geographies of alcohol and generation: Examining the decline in youth drinking in England through a spatial lens.","author":"L Fenton","year":"2023","journal-title":"Drug Alcohol Rev"},{"key":"pone.0305124.ref014","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.puhe.2011.09.014","article-title":"Rethinking drinking cultures: A review of drinking cultures and a reconstructed dimensional approach.","volume":"126","author":"R Gordon","year":"2012","journal-title":"Public Health"},{"key":"pone.0305124.ref015","article-title":"Growing up unequal: gender and socioeconomic differences in young people\u2019s health and well-being Health Behaviour in School-aged Children (HBSC) study: international report from the 2013\/2014 survey.","author":"J Inchley","year":"2016","journal-title":"Copenhagen"},{"key":"pone.0305124.ref016","doi-asserted-by":"crossref","first-page":"S40","DOI":"10.1016\/j.jadohealth.2020.02.012","article-title":"Clusters of Contemporary Risk and Their Relationship to Mental Well-Being Among 15-Year-Old Adolescents Across 37 Countries.","volume":"66","author":"SD Walsh","year":"2020","journal-title":"J Adolesc Heal."},{"key":"pone.0305124.ref017","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1007\/s11121-007-0070-9","article-title":"How many imputations are really needed? 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