Clustering of Behavioural Risk Factors in Jordan: A Stratified, Policy-Driven Analysis of WHO STEPS 2019

Behavioural risk factors for non-communicable diseases (NCDs) often cluster within populations, increasing the risk of morbidity and mortality. Jordan faces a high burden of smoking, physical inactivity, and poor diet, yet national analyses have not examined how these risks co-occur across demographic groups.We used nationally representative data from the WHO STEPS 2019 survey in Jordan (n = 4,755) to assess the clustering of three behavioural risk factors: tobacco use, low fruit/vegetable intake, and physical inactivity. A composite risk score (0–3) was constructed. Descriptive statistics, logistic regression, and behaviour pairing analyses were stratified by sex, nationality (Jordanian vs Syrian), and region (North, Centre, South).73.5% of adults had ≥ 2 behavioural risks, and 15.9% had all three. Clustering prevalence was highest in the North (74.7%), followed by Centre (73.2%) and South (69.7%). Among those with three risks, 69.4% were men; among those with two risks, 68.7% were women. Syrians were more concentrated in the two-risk category, while Jordanians dominated the three-risk group. Logistic regression showed women had 78.7% lower odds of being in the 3-risk group (OR = 0.213, p < .001), and Syrians had 21% lower odds than Jordanians (OR = 0.792, p = .007). The most common behavioural combinations were inactivity + poor diet (71.7%) and smoking + inactivity (74.8%).This is the first nationally representative study in Jordan to quantify behavioural risk clustering by region, sex, and nationality. Our findings reveal clear opportunities to design bundled interventions targeting common risk combinations, especially among men and in high-burden regions. Results are immediately relevant for national NCD planning and WHO HEARTS implementation in Jordan.