Self-control (SC) has been consistently found associated with diverse health risk behaviors (HRBs), but little research refers to low- and middle-income countries. Furthermore, there is evidence that some HRBs tend to aggregate, however studies with the specific purpose of addressing the relation between SC and multiple health risk behaviors (MHRBs) are rare. The objective of this study is to analyze these associations and provide evidence to help filling these gaps. A sample of 2106 9th grade students from the city of São Paulo responded a self-administered questionnaire in 2017. We tested the association of SC measured as an ordinal variable with four levels (higher, high, medium and low) with six HRBs (binge drinking, marijuana use, smoking, high consumption of ultra-processed food, sedentary behavior and bullying perpetration), in both separated and aggregated forms (MHRBs), controlling for potential confounders. Binary logistic regression was used to test the association between exposure (SC) and single outcomes. In order to analyze the association of SC with MHRBs, multinomial logistic regression was employed. SC was associated with five of six HRBs investigated and with MHRBs. The effect size of the association of SC and MHRBs increased in a steep pattern with accumulation of more HRBs. Low self-control is associated with most HRBs investigated and the magnitude of the association increases when more than two or three HRBs are accumulated. There seems to be a group of adolescents in a position of pronounced vulnerability for MHRBs. This should be considered when designing public policy and prevention programs. In contexts of limited or scarce resources and public funds, interventions focusing the most vulnerable groups, instead of universal interventions, should be considered.

中文翻译：

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自我控制与健康风险行为之间的关联：一项对圣保罗 9 年级青少年的横断面研究

自我控制 (SC) 一直被发现与多种健康风险行为 (HRB) 相关，但很少有研究涉及低收入和中等收入国家。此外，有证据表明一些 HRB 趋于聚合，但针对解决 SC 与多种健康风险行为 (MHRB) 之间关系的特定目的的研究很少。本研究的目的是分析这些关联并提供证据来帮助填补这些空白。2017 年，来自圣保罗市的 2106 名 9 年级学生样本回答了自我管理的问卷。饮酒、吸食大麻、吸烟、大量食用超加工食品、久坐行为和欺凌行为），以分离和聚合形式（MHRBs），控制潜在的混杂因素。二元逻辑回归用于测试暴露 (SC) 和单一结果之间的关联。为了分析 SC 与 MHRB 的关联，采用多项逻辑回归。SC 与被调查的六个 HRB 中的五个和 MHRB 相关。随着更多 HRB 的积累，SC 和 MHRB 关联的影响大小以陡峭的模式增加。低自我控制与大多数调查的 HRB 相关，并且当累积超过两个或三个 HRB 时，关联的程度会增加。似乎有一群青少年对 MHRB 处于明显的脆弱状态。在设计公共政策和预防计划时应考虑到这一点。