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Effect of multiple risk behaviours in adolescence on educational attainment at age 16 years: a UK birth cohort study
  1. Caroline Wright,
  2. Ruth Kipping,
  3. Matthew Hickman,
  4. Rona Campbell,
  5. Jon Heron
  1. Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
  1. Correspondence to Dr Caroline Wright; caroline.wright{at}


Objectives To explore the association between adolescent multiple risk behaviours (MRBs) and educational attainment.

Design Prospective population-based UK birth cohort study.

Setting Avon Longitudinal Study of Parents and Children (ALSPAC), a UK birth cohort of children born in 1991–1992.

Participants Data on some or all MRB measures were available for 5401 ALSPAC participants who attended a clinic at age 15 years and/or completed a detailed questionnaire at age 16 years. Multiple imputation was used to account for missing data.

Primary outcome measures Capped General Certificate of Secondary Education (GCSE) score and odds of attaining five or more GCSE examinations at grades A*–C. Both outcome measures come from the National Pupil Database and were linked to the ALSPAC data.

Results Engagement in MRB was strongly associated with poorer educational attainment. Each additional risk equated to −6.31 (95% CI −7.03 to −5.58, p<0.001) in capped GCSE score, equivalent to a one grade reduction or reduced odds of attaining five or more A*–C grades of 23% (OR 0.77, 95% CI 0.74 to 0.81, p<0.001). The average cohort member engaged in 3.24 MRB and therefore have an associated reduction in GCSE score equivalent to three and a half grades in one examination, or reduced odds of attaining five or more A*–C grades of 75%.

Conclusion Engagement in adolescent MRB is strongly associated with poorer educational attainment at 16 years. Preventing MRB could improve educational attainment and thereby directly and indirectly improve longer-term health.

  • multiple risk behaviours
  • adolescence
  • educational attainment
  • UK birth cohort study

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  • Contributors CW, RK, MH, RC and JH conceived and designed the study. CW and JH carried out the study, including acquiring and analysing the data. CW and JH interpreted the data. CW drafted the manuscript. RK, MH, RC and JH critiqued the manuscript for important intellectual content. All authors read and approved the final version of the manuscript. CW serves as guarantor. MH and RC are senior investigators for the National Institute for Health Research. CW and JH had full access to all of the data and can take responsibility for the integrity of the data and the accuracy of the data analysis. CW, RK, MH, RC and JH had access to the statistical outputs, reports and tables. All researchers are independent of the funding bodies.

  • Funding ALSPAC receives core support from the UK Medical Research Council and the Wellcome Trust (grant ref: 092731) and the University of Bristol. This work was undertaken with the support of the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UKCRC Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical approval for the study was obtained from the ALSPAC Ethics and Law Committee and local Research Ethics Committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The ALSPAC policy on data sharing is available at To discuss access to ALSPAC data, please contact the ALSPAC executive team on

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