Background: Non-communicable diseases (NCDs) have become the leading cause of deaths globally and the key associated risk factors – alcohol abuse, physical inactivity, cigarette smoking and poor dietary patterns – are often initiated in adolescence. Co-existence of these risk factors further increase the risk for NCDs. Yet, very little is known about the pattern of co-occurrence of behavioural risk factors for NCDs among Nigerian adolescents, especially those in rural areas. This study aimed to assess the prevalence and determinants of clustering patterns of behavioural risk factors for NCDs among in-school adolescents in rural areas of Osun State, Nigeria.

Methods: This cross-sectional study involved 476 adolescents recruited through multi-stage sampling across Osun State. Data were collected through a facilitated self-administered questionnaire with questions adapted from the Global School-Based Health Survey (GSHS) instrument. Data were analysed using Stata, with binary logistic regression used to identify determinants.

Results: The mean age of the respondents was 14.7±2.0 years and females constituted 50.2% of them. Among the respondents, 36.1% had reported consuming alcoholic drinks but no one met the criteria for harmful alcohol use, while 8.8% had ever smoked cigarettes and only one respondent (0.2%) was a current smoker. The prevalence of poor diet (89.5%) and physical inactivity (85.9%) was, however, high. Poor diet and physical inactivity co-occurred in 369 (77.5%) respondents, while one respondent (0.2%) had three risk factors (poor diet, physical inactivity and current smoking). Being in a senior secondary school class (odds ratio, OR=1.6; 95% confidence interval, C.I.=1.04–2.39) and living with parents (OR=0.53; 0.33–0.90) were significantly associated with clustering of NCD behavioural risk factors.

Conclusion: The prevalence of clustering of modifiable risk factors for NCDs was high among rural-based in-school adolescents in south-west Nigeria, and there is a need to mount effective interventions. Findings from this study have the potential to inform effective school-based NCD control programmes.