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Background  Childhood lifestyle, health-risk behaviours contribute to two-thirds of non-communicable diseases (NCDs) premature mortality in adult populations. The co-occurrence of risk factors for NCDs is more harmful to health than that of individual risk factor effects when are added independently. The main objective of the present study was to explore the prevalence, sociodemographic distribution, and the co-occurrence of risk factors for NCDs among in-school adolescents.    Methods  The present study is based on the secondary analysis of the first nationwide representative sample of the 2014 Tanzania Global School-based Student Health Survey (GSHS). A total sample of 3,793 in-school adolescents was included in the present analysis. The dependent variables were as follows: an unhealthy diet, physical inactivity, tobacco use, excessive alcohol use, and suicide attempt. The analysis involved the Chi squire χ 2  test, multinomial and multivariate regression models: to determine the association between the variables of interest. In all analyses, the set level of statistical significance was a  p -value of less than 0.05 at 95% confidence intervals.    Results  The most prevalent combination of risk factors for NCDs were as follows: unhealthy diet and physical inactivity 666 (17.6%); unhealthy diet and suicide attempt 151 (4.0); unhealthy diet and tobacco use 98 (2.8); and unhealthy diet, physical inactivity, and suicide attempt 81 (2.1). In the adjusted regression model; having three 0.60 [0.40–0.91], and a sum of four and five 0.46 [0.28–0.79] risk factors than having no risk factor showed a significant declined with increasing in adolescents age. Primary in-school adolescents than secondary in-school adolescents were significantly more likely to have two 1.81 [1.42–2.32], three 2.40 [1.63–3.54]; and a sum of four and five 2.90 [1.61–5.13] combinations of risk factors.    Conclusion  The co-occurrence of lifestyle health-risk factors for NCDs was prevalent among in-school adolescents: it was significantly higher among younger adolescents. A multi-strategy public health intervention program may be more effective than that of a single risk factor approach: therefore, suitable for resource-limited settings, such as Tanzania.

bmc public health

Co-occurrence of risk factors for non-communicable diseases among in-school adolescents in Tanzania: an example of a low-income setting of sub-Saharan Africa for adolescence health policy actions