Biopsychosocial Factors of Adolescent Health Risk Behaviours during the COVID-19 Pandemic—Insights from an Empirical Study

Abstract

The paper focuses on the association between Bulgarian adolescents’ health risk behaviours (cigarette smoking, vaping, alcohol use and drunkenness) and biopsychosocial factors at individual and interpersonal levels, using data from the pre-pandemic and the pandemic periods, i.e. Health Behaviour in School-aged Children (HBSC) study (2018) and the study of adolescent health and well-being in the context of the COVID-19 pandemic (2022/2023). Logistic regression models reveal a positive association with age in both periods, decreasing gender difference in smoking, presistant effect of family structure, strengthened effect of the material status of the family and a differenciating effect of ethnicity at the end of the pandemic. Family support is positively asociated with substance (mis)use in both periods. At the end of the pandemic generalized anxiety is positively associated with substance (mis)use, loneliness has a negative association with drunkenness, and limited social interaction and vaping are in a positive relationship. The experience of COVID-19 infection in the family is associated with higher risk of smoking, while treatment in hospital for COVID-19 of the adolescent or a family member is associated with a higher risk of vaping and drunkenness. Interactions with COVID-19 experience and psychosocial variables reveal a divergence in health risk behaviours, including also engagement in substance (mis)use. Effective interventions, targeting the identified risk factors and risk groups, are needed for promotion of healthy lifestyles among adolescents.