A latent class analysis of co-occurring substance use, suicidality, and violence-related behaviors among Moroccan adolescents
AI Summary
Four latent classes found: low risk (54.2%), high violence only (21.3%), moderate violence with high suicidality (12.5%), poly-risk with high violence and substance use (12.0%).
Rural residence, parental tobacco use, secondhand smoke exposure and lacking close friends significantly increased odds of membership in the poly-risk class.
Consistent school attendance was protective, suggesting integrated, context-specific interventions promoting family engagement, school connectedness and multi-component prevention to mitigate compounded adolescent risks.
Int J Adolesc Med Health. 2026 May 28. doi: 10.1515/ijamh-2025-0154. Online ahead of print.
ABSTRACT
OBJECTIVES: Adolescents face co-occurring health risk behaviors contributing synergistically to adverse health outcomes. Evidence on these patterns of co-occurrences in low- and middle-income countries is limited. This study aimed to identify latent classes based on patterns of substance use, suicidality, and violence-related behaviors among Moroccan adolescents and examine sociodemographic, risk, and protective factor correlates of class membership.
METHODS: We conducted a secondary analysis of the 2016 Morocco GSHS, which included 6,745 adolescents aged 13-17 years. Latent class analysis was performed using 12 binary indicators of violence, bullying, injury, suicidality, and substance use. Multinomial logistic regression assessed the associations between latent class membership and covariates, including sociodemographic factors, risk behaviors, and protective factors.
RESULTS: A four-class solution provided the best fit. Class 1 (“low engagement in risk behaviors” 54.2 %) showed minimal involvement in all risks. Class 2 (“high violence, low suicidality and substance use” 21.3 %) was marked by elevated violence. Class 3 (“moderate violence and high suicidality” 12.5 %) was dominated by suicidality coupled with moderate violence. Class 4 (“high violence, moderate suicidality and high substance use,” 12.0 %) reflected poly-risk engagement. Rural residence, parental tobacco use, secondhand smoke exposure, and having no close friends significantly increased the odds of poly-risk class membership. Consistent school attendance emerged as a significant protective factor.
CONCLUSIONS: Distinct clusters of adolescent health risk behaviors were identified. Integrated, context-specific interventions that enhance family engagement, school connectedness, and multi-component prevention could mitigate compounded risks and improve adolescent health in Morocco.
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