To examine the association between the left-behind status and health risk behaviors (HRB) among adolescents, so as to provide empirical evidence for identifying high-risk groups and developing intervention measures for HRB.

From October to November 2023, by using a combination of convenient sampling and cluster sampling, 14 964 adolescents from 6 schools in a county-level city in Hubei Province (3 junior high schools and 3 senior high schools) and 7 schools in a county-level city in Hunan Province (all junior high schools) were selected as the research subjects. The adolescents were divided into non-left-behind, father-absent, mother-absent, and both parents absent groups based on their left-behind status. A self-designed adolescent HRB questionnaire was utilized to investigate the prevalence of 12 types of HRBs and their co-existence among the subjects. Multifactorial Logistic regression and unordered multinomial Logistic regression analyses were used to explore the association between the left-behind status of adolescents and the occurrence of individual HRBs as well as the co-existence of multiple HRBs.

After controlling for gender, age, only child, and subjective socioeconomic status, the results of the multiple factor Logistic regression analysis showed that having father in absence for working was positively associated with screen use long time on school days (OR=1.15, 95%CI=1.05-1.26) and rest days (OR=1.16, 95%CI=1.06-1.26); having mother in absence for working was significantly associated with increased risks of smoking (OR=1.68, 95%CI=1.22-2.32), spending long time on screen during school days (OR=1.19, 95%CI=1.00-1.41)and rest days (OR=1.36, 95%CI=1.16-1.59), skipping breakfast (OR=1.20, 95%CI=1.03-1.39), skipping dinner (OR=1.20, 95%CI=1.01-1.43), not eating fruit (OR=1.34, 95%CI=1.12-1.61), and consuming sugar-sweetened beverages (OR=1.30, 95%CI=1.09-1.55); having both parents in absence for working was positively associated with screen use on rest days (OR=1.51, 95%CI=1.38-1.65), skipping dinner (OR=1.15, 95%CI=1.04-1.27), not eating fruit (OR=1.80, 95%CI=1.62-1.99), and non-suicidal self-injury (OR=1.16, 95%CI=1.04-1.29), and negatively associated with fast food consumption (OR=0.72, 95%CI=0.65-0.79)(all P < 0.05).The results of unordered multiclass Logistic regression analysis showed that mother absence for working was associated with an increased risk of moderate and high co-occurrence of HRBs (OR=1.25, 95%CI=1.06-1.47; OR=1.67, 95%CI=1.30-2.13), both parents absence for working was also positively correlated with a high co-occurrence risk of HRBs (OR=1.29, 95%CI=1.11-1.50) (all P < 0.05).

Father absence for working is only related to adolescents' screen time, while adolescents with mother absence or both parents absent for working are priority groups for HRB prevention.