Social profiles of cancer risk awareness and health behaviours among European adolescents. A cross-country study

Background: Cancer prevention during adolescence remains a major public health challenge. Although cancer-related risk behaviours emerge early in life, adolescents’ engagement in these behaviours does not consistently align with their awareness of associated cancer risks. Methods: Data were drawn from a cross-sectional online survey conducted within the SUNRISE project, including 4,054 adolescents aged 12–18 years from eight European countries. A two-step cluster-analytic approach was applied, combining hierarchical clustering with Ward’s method and k-means clustering. Clusters were defined based on engagement in unhealthy behaviours (smoking, alcohol consumption, unhealthy eating), cancer-risk perception and perceived health. Results: Five distinct adolescent profiles were identified: (1) The Unconcerned and Mostly Healthy (n = 918), characterised by low engagement in unhealthy behaviours, limited cancer-risk awareness associated with alcohol consumption and unhealthy eating, and good perceived health; (2) The Health Savvy (n = 1,868), who abstain from unhealthy behaviours, demonstrate high cancer-risk awareness, and report excellent health; (3) The Unaware Health Risk-Takers (n = 464), who frequently engage in unhealthy behaviours—particularly smoking and alcohol use—while underestimating associated cancer risks and reporting poorer health; (4) The Health-Aware Risk-Takers (n = 521), who engage heavily in unhealthy behaviours despite recognising their cancer risks and report average health; and (5) The Health-Unaware Abstainers (n = 283), who avoid unhealthy behaviours but display low cancer-risk awareness and average perceived health. Conclusions: Adolescents’ health behaviours and cancer-risk awareness cluster into distinct profiles not captured by socio-demographic characteristics alone, highlighting the need for profile-specific cancer prevention strategies.