Individual and neighborhood social determinants and high-risk behaviors among Puerto Rican young adults: A cross-sectional analysis of the PR-OUTLOOK Study

Abstract Background Health-risk behaviors, including tobacco use, excessive alcohol consumption, and physical inactivity, contribute to chronic disease and are shaped by individual and neighborhood social conditions. However, little is known about how individual social disadvantage and neighborhood social vulnerability relate to health-risk behaviors among young adults residing in Puerto Rico. The objectives of this study were to examine associations between individual- and neighborhood-level social determinants of health and engagement in high-risk behaviors among Puerto Rican young adults residing in Puerto Rico. Methods We analyzed baseline data (2020–2024) from the PR-OUTLOOK cohort, including 2,727 adults aged 18–29 years residing in Puerto Rico. Individual-level social determinants of health were analyzed using a latent factor score derived from ten indicators and categorized into tertiles (least, moderate, and most disadvantaged). Neighborhood-level social vulnerability was assessed using the census-tract level Social Vulnerability Index (continuous range: 0–1.0). Five binary high-risk behavior outcomes were analyzed: cigarette smoking, e-cigarette use, recreational marijuana use, binge drinking, and physical inactivity. Poisson regression with robust standard errors was used to estimate adjusted prevalence ratios (aPRs) for individual-level social determinant groups; models were subsequently stratified by sex to assess sex-specific associations. Fixed-effects logistic regression with cluster-robust standard errors at the census-tract level was used to estimate adjusted odds ratios (aORs) for individual-level social determinants of health and neighborhood-level social vulnerability. Results Among participants, 33.7% reported one high-risk behavior, 25.1% reported two, and 18.5% reported three or more. Compared with the least disadvantaged group, individuals in the most disadvantaged social determinants of health tertile had a higher prevalence of cigarette smoking (aPR: 1.71) and physical inactivity (aPR: 1.24), with stronger and more consistent associations observed among female participants. At the neighborhood-level, higher social vulnerability score was associated with increased odds of binge drinking (aOR: 1.85) but lower odds of e-cigarette and marijuana use. Conclusions In this cohort of Puerto Rican young adults, both individual-level and neighborhood-level social disadvantage were associated with selected high-risk health behaviors, particularly among female participants. Future longitudinal studies are needed to elucidate causal pathways and inform multi-level interventions aimed at reducing disparities in high-risk health behaviors in this population.